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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Health Care Management and Policy, University of Surrey, GUILDFORD, GU2 7XH, UK.
Victoria
V
Woodhams
Simon
S
de Lusignan
Shakeel
S
Mughal
Graham
G
Head
Safia
S
Debar
Terry
T
Desombre
Sean
S
Hilton
Houda
H
Al Sharifi
D019058:Community Networks; D004630:Emergencies / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006300:Health Services Misuse; D006699:Home Care Services; D006801:Humans; D007858:Learning; D008131:London; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission; D010359:Patient Readmission / Q000639:trends*; D011787:Quality of Health Care