Background:
Internationally health services are facing increasing demands due to new and more expensivehealth technologies and treatments, coupled with the needs of an ageing population. Reducingavoidable use of expensive secondary care services, especially high cost admissions where noprocedure is carried out, has become a focus for the commissioners of healthcare.MethodWe set out to identify, evaluate and share learning about interventions to reduce avoidablehospital admission across a regional Academic Health and Social Care Network (AHSN). Weconducted a service evaluation identifying initiatives that had taken place across the AHSN.This comprised a literature review, case studies, and two workshops.
Results:
We identified three types of intervention: pre-hospital; within the emergency department(ED); and post-admission evaluation of appropriateness. Pre-hospital interventions includedthe use of predictive modelling tools (PARR – Patients at risk of readmission and ACG -Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GPadvisersand outreach nurses were employed within the ED. The principal post-hocinterventions were the audit of records in primary care or the application of theAppropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was ashortage of independent evaluation and limited evidence that each intervention had an impacton rates of admission.
Conclusions:
Despite the frequency and cost of emergency admission there has been little independentevaluation of interventions to reduce avoidable admission. Commissioners of healthcareshould consider interventions at all stages of the admission pathway, including regular audit,to ensure admission thresholds don’t change.