How Hospitals Can Avoid Unnecessary Acute Care Admissions

United Kingdom study offers advice for EDs

A new study investigating how hospitals try to avoid unnecessary emergency admissions has identified a series of innovations that could help to address the problem.

Researchers in the United Kingdom have investigated how the emergency departments and staff of four major hospitals in the southwest of England respond to emergency care pressures and the experiences of their patients. The findings were published in Health Services and Delivery Research.

The study found that the likelihood of a decision being made to admit a patient to a hospital was not determined solely by the medical diagnosis and perceived risk; it was also influenced by, among other things, the seniority and experience of the clinical staff making the decisions, the patient's social circumstances, access to certain investigations, and the availability of time to arrange alternatives to hospital admission where these existed.

The study identified new ways of using hospital “space.” Clinical-decision units and observation wards allowed potentially dischargeable patients with medical and/or social complexity to be “off the clock,” allowing time for tests, observation, or safe discharge. New teams supported admission avoidance: an acute general practitioner service filtered patients prior to arrival; discharge teams worked with community services; and specialist teams for the elderly facilitated outpatient treatment. Senior doctors had a range of roles: evaluating complex patients, advising and training juniors, and overseeing emergency department activity. Other innovations included ambulatory care units and the availability of rapid-access outpatient clinics.

Early patient assessment by senior staff always played a central role in reducing admissions in all four hospitals, but their expertise was deployed in different ways, including in a purely advisory “controller” capacity supporting trainees and other frontline staff, the study found.

The study also found that, overall, patients were happy with their experience of hospital emergency care. For medical and nursing staff, there were concerns regarding the pressures of work, staff retention, and the use of substitute staff––an observation that emphasized the importance of continuity in both medical teams and patient care.

Sources: EurekAlert; January 29, 2016; and Health Services and Delivery Research; January 2016.