Improving specialised care for neuromuscular patients reduces the frequency of preventable emergency hospital admissions

• Published in: Neuromuscular disorders : NMD 2020-02, Vol.30 (2), p.173-179
• Main Authors: Scalco, Renata S., Quinlivan, Rosaline M., Nastasi, Laura, Jaffer, Fatima, Hanna, Michael G.
• Format: Article
• Language: English
• Subjects: A&E; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cross-Sectional Studies; Emergency admissions; Emergency Medical Services - standards; Emergency Medical Services - statistics & numerical data; England; Female; Humans; Infant; Male; Medical Audit - statistics & numerical data; Middle Aged; National Health Programs - standards; National Health Programs - statistics & numerical data; Neuromuscular diseases; Neuromuscular Diseases - therapy; NHS; Patient Admission - standards; Patient Admission - statistics & numerical data; Patient Education as Topic; Process Assessment, Health Care - statistics & numerical data; Public Health; Quality Improvement - standards; Quality Improvement - statistics & numerical data; Retrospective Studies; Young Adult
• ISSN: 0960-8966; 1873-2364
• DOI: 10.1016/j.nmd.2019.11.013

•Emergency admissions are frequent in people with NMD.•Preventing emergency admissions improves quality of life.•Anticipatory care prevents admission.•Quality of life is improved.•Health care costs are reduced. Two retrospective audits were undertaken across several hospitals to understand the frequency and preventability of emergency admissions in people with neuromuscular disease (NMD). Following audit 1 (A1), a number of preventable themes emerged on the basis of which recommendations were made to improve quality and co-ordination of care and a network approach was developed to improve awareness and education amongst patients and non-expert professionals. Audit 2 (A2) was undertaken to determine the effect of these measures. The central NHS IT database identified emergency NMD admissions. Case notes were reviewed and audited against pre-agreed criteria. A1 included 576 admissions (395 patients) A2 included 361 admissions (314 patients). Preventable admissions (where an NMD was known) accounted for 63% in A1 and 33% in A2, with more patients followed up at a specialised neuromuscular centre in A2. There were fewer re-admissions in A2 (12%) compared with A1 (25%) and lower mortality (A1: 4.5%, A2: 0.3%). A2 showed a significant rise in patients admitted under the care of neuroscience during the acute admission and fewer preventable ITU admissions. These audits demonstrate a significant impact for both patient care and potential for financial savings following the implementation of recommendations made after A1.