Who knows best? Older people’s contribution to understanding and preventing avoidable hospital admissions
This video is based up the findings of a new study conducted by the University of Birmingham’s Health Services Management Centre and the Department of Social Policy and Social Work. Working with 104 older people and 40 local professionals, the research looked at how the older people were admitted to hospital, whether they felt this was the best place for them and what alternatives might have been explored. Similar questions were also asked of a GP and / or hospital doctor representing as many of these older people as possible.
Key findings from the study
- Nine older people (nine per cent) felt they could have been cared for elsewhere. Their GPs or hospital doctors felt their admissions (and those of other people on whom they commented) were entirely appropriate.
- Contrary to some media speculation, some older people appeared to have delayed getting in touch with emergency services, being very aware of the need to use scarce NHS resources wisely.
- While there was evidence of good initiatives to try and divert older people from hospital, the ways into these services were sometimes complicated, for older people and professionals alike.
- In the run up to admission, GPs and other primary care professionals were often in touch with the older people and at the point of admission, ambulance staff played a key role.
- Health staff felt that hospital admission was more likely to be avoided if older people had early access to specialist staff who understood the complexity of the health and social problems that older people may experience.
- Few older people mentioned receiving social care services prior to admission and staff felt that social care services needed more funding and capacity in order to prevent emergency admissions.
- A minority of respondents had dementia and their family members felt that some hospital services did not meet the needs of patients with dementia. They also felt that social care services were inadequate.
A number of themes for good practice emerged from the key findings
- Conditions where older people don’t feel a ‘burden’ need to be created. The study did not find large numbers of older people being inappropriately admitted to hospital; rather evidence was found of older people doing their best to stay out of hospital.
- Community services which could prevent hospital admissions and/or ensure a speedy discharge should be accessible and timely. Both hospital and community services need to be clear with staff and patients about their priorities and criteria for access.
- Avoiding admissions needs experienced, timely assessment – GPs, paramedics and hospital staff have a key role to play.
- Issues of capacity and funding in social care services need to be addressed if they are to play an active role in preventing hospital admissions.
- Increased dementia training for hospital staff and dementia-friendly environments are important considerations.
