Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways.
BACKGROUND
There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions.


OBJECTIVE
To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions.


METHODS
A qualitative framework analysis of interview data from a System dynamics (SD) modelling study.


METHODS
Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis.


RESULTS
Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign.


CONCLUSIONS
Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system.


CONCLUSIONS
Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs.
Centre for Innovation & Leadership in Health Sciences, Faculty of Health Sciences, University of Southampton, Southampton, UK.
Bronagh
B
Walsh
Valerie
V
Lattimer
Julie
J
Wintrup
Sally
S
Brailsford
D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015577:Geriatric Assessment; D006301:Health Services Needs and Demand; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D010343:Patient Admission; D006113:United Kingdom
admission avoidance; frailty; framework analysis; hospital admissions; older people; system dynamics modelling