title: The hospital admissions study in England: are there alternatives to emergency hospital admission?
abstract: OBJECTIVE
  To assess the potential for substituting alternative forms of care for admission to an acute hospital in particular groups of patients.
  
  
  METHODS
  A screening tool, the intensity-severity-discharge review system with adult criteria (ISD-A), developed for hospital utilisation review in the USA, was used in a cohort of hospital admissions to identify a group of patients who could potentially have been treated outside the acute hospital. These patients were further assessed by a panel of general practitioners (GPs) to determine the most appropriate alternative form of care. A cost analysis was performed on the results obtained.
  
  
  METHODS
  General medicine and geriatric specialties in one acute hospital in the south western region.
  
  
  METHODS
  Patients comprised a sample of 701 admitted to general medical and geriatric specialties.
  
  
  RESULTS
  The screening tool identified 19.7% of admissions for whom there was potential for treatment outside the acute hospital. Assessment by the GP panel reduced this potential to between 9.8% and 15.0% of emergency admissions. The alternatives most frequently identified as "most appropriate" were the community hospital/GP bed and the urgent outpatient assessment (within either 24 or 48 hours). Potential resource savings based on the average cost were relatively small. This potential seemed to be greater for the alternative of the urgent outpatient assessment.
  
  
  CONCLUSIONS
  Potential exists for treating a proportion of patients in lower intensity alternatives to the acute hospital. If this potential were exploited few resource savings would occur.
authors.affiliation: Health Care Evaluation Unit, University of Bristol.
authors.forename: J
authors.initials: J
authors.lastname: Coast
authors.forename: A
authors.initials: A
authors.lastname: Inglis
authors.forename: K
authors.initials: K
authors.lastname: Morgan
authors.forename: S
authors.initials: S
authors.lastname: Gray
authors.forename: M
authors.initials: M
authors.lastname: Kammerling
authors.forename: S
authors.initials: S
authors.lastname: Frankel
mesh_terms: D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data; D004630:Emergencies; D004739:England; D005194:Family Practice; D005260:Female; D006295:Health Resources; D017721:Hospital Costs; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D012017:Referral and Consultation