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Reducing avoidable acute admissions to hospitals

Posted on January 29th 2016

A team from PenCLAHRC investigating how hospitals try to avoid unnecessary emergency admissions has identified a series of innovations that can help to address this pressing problem.

Emergency admissions to UK hospitals are on the rise, and in recent months, an increasing number of hospitals have been put on black alert as a result of these added pressures. There is evidence that a significant proportion of acute hospital admissions are avoidable, and hospitals across the country have introduced a range of innovative initiatives to try to avoid these unnecessary admissions. Until now, there has been no research to investigate how well such measures work in practice and whether they meet the needs of patients.

The PenCLAHRC team in Plymouth collaborated with experts from the University of the West of England, University of Bristol, and the University of Exeter in order to carry out research to investigate how the emergency departments and staff of four major hospitals in the south west of England respond to emergency care pressures and the experience of their patients.

The study, which was funded by the NIHR Health Services and Delivery Programme, found that the likelihood of a decision being made to admit a patient to hospital was not determined solely by the medical diagnosis and perceived risk, but was also influenced by the:

  • Seniority and experience of the clinical staff making the decisions
  • Patient’s social circumstances
  • Access to certain investigations
  • Proximity of the four-hour target
  • Availability of time to arrange alternatives to hospital admission where these existed.

The approaches taken to reducing unnecessary admissions varied considerably across the four hospitals, however, and it was evident that the various innovations had been developed to respond to local need. Some of these approaches included:

  • A hospital based acute GP service
  • Outpatient care units
  • Discharge assessment procedures and teams for elderly patients
  • Availability of rapid access outpatient clinics
  • Use of observation areas where patients were not subject to the four hour target – allowing more time to gather vital medical and social information, observe, investigate and make arrangements that could avoid hospital admission.

Common to all four hospitals, however, was the central role played by early patient assessment by senior staff.

The study found that, on the whole, patients were very happy with their experience of hospital emergency care although they were also aware of the severe pressures on these hospitals. For medical and nursing staff of all grades there were concerns around pressure of work, staff retention, but also the use of locum staff.

The study was led by Professor Jonathan Pinkney and Professor Richard Byng. Professor Pinkney said:

“Hospitals and their staff are under immense pressure to ensure that each and every patient receives the best and most appropriate treatment. The emergency department is a particular pressure point and we were impressed by how each of the four hospitals in the study addressed the issue of avoiding admitting patients to the ward where it was unnecessary. While there were common themes in how the hospitals approached this issue, the systems and innovations they put in place were informed by local knowledge and need.”

Professor Richard Byng commented:

"The results of this study show that there is a range of different methods that hospitals can use to safely reduce numbers of potentially avoidable hospital admissions and improve patient care. Some of these approaches are already in use, whereas others could be more widely adopted or scaled up in ways that could contribute to reducing pressures on acute hospitals.”

This study, capturing the experiences of patients and staff and informs the ongoing debate about how to reduce avoidable admissions. The information can assist policy makers with the evidence they need in order to advise on innovations that can improve NHS performance and most importantly patient experience.

You can read the full study report in the NIHR Health Services and Delivery Research Journal.

For more information, please visit the Avoidable Acute Admissions project page.

Reference

Pinkney J, Rance S, Benger J, Brant H, Joel-Edgar S, Swancutt D, et al. How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions? A mixed-methods study of four acute hospitals. Health Serv Deliv Res 2016;4(3). DOI: 10.3310/hsdr04030

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