Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

• Published in: BMC health services research 2012-06, Vol.12 (1), p.153-153, Article 153
• Main Authors: Woodhams, Victoria, de Lusignan, Simon, Mughal, Shakeel, Head, Graham, Debar, Safia, Desombre, Terry, Hilton, Sean, Al Sharifi, Houda
• Format: Article
• Language: English
• Subjects: (MeSH): Hospitalization; Admission and discharge; Analysis; Case management; Case studies; Community Networks; Cost control; Economic aspects; Emergencies - epidemiology; Emergency medical care; Health Knowledge, Attitudes, Practice; Health services; Health Services Misuse; Home care; Home Care Services; Hospital based [economics; Hospitalization; Hospitals; Humans; Intervention; Learning; Literature reviews; London; Medical care, Cost of; Nurses; organisation and administration; Organizational Case Studies; Outcome and Process Assessment, Health Care; Patient Admission; Patient admissions; Patient Readmission - trends; Patients; Primary care; Quality of Health Care; Teams; Workshops
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/1472-6963-12-153

Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change.