The emergency bed service--a barometer of London's hospital service.

The emergency bed service in London exists to facilitate admissions to hospital in cases referred to them by general practitioners and deputizing doctors. The data collected by the emergency bed service provides a unique London-wide perspective of the hospital service and the recent changes observed are examined in this paper. When the emergency bed service fails to arrange for the admission of a patient after trying at least four hospitals the case is medically refereed. The number of cases reviewed by the medical referee has increased over the period 1976-86 as has the necessity for hospitals to stop or slow nonemergency admissions (red and yellow alerts). External factors, such as severe weather and influenza epidemics, were examined to see whether they could account for these changes. However, it was concluded that bed closures accounted for the changes and were making it more difficult to obtain hospital admission for emergency cases via the emergency bed service in Greater London.