Results for 'hospital admission'
Results 1 - 10 of 21
PUGH Jacqueline, et al
Background: 30-day hospital readmissions are an indicator of quality of care; hospitals are financially penalized by Medicare for high rates. Numerous care transition processes reduce readmissions in clinical trials. The objective of this study was to examine the relationship between the number of evidence-based transitional care processes used and the risk standardized readmission rate (RSRR). Methods: Design: Mixed method, multi-stepped observational study. Data collection occurred 2014–2018 with data analyses completed in 2021. Setting: Ten VA hospitals, chosen for 5-year trend of improving or worsening RSRR prior to study start plus documented efforts to reduce readmissions. Participants: During five-day site visits, three observers conducted semi-structured interviews (n = 314) with staff responsible for care transition processes and observations of care transitions work (n = 105) in inpatient medicine, geriatrics, and primary care. Exposure: Frequency of use of twenty recommended care transition processes, scored 0–3. Sites’ individual process scores and cumulative total scores were tested for correlation with RSRR. Outcome: best fit predicted RSRR for quarter of site visit based on the 21 months surrounding the site visits. Results: Total scores: Mean 38.3 (range 24–47). No site performed all 20 processes. Two processes (pre-discharge patient education, medication reconciliation prior to discharge) were performed at all facilities. Five processes were performed at most facilities but inconsistently and the other 13 processes were more varied across facilities. Total care transition process score was correlated with RSRR (R2 = 0..61, p < 0.007). Conclusions: Sites making use of more recommended care transition processes had lower RSRR. Given the variability in implementation and barriers noted by clinicians to consistently perform processes, further reduction of readmissions will likely require new strategies to facilitate implementation of these evidence-based processes, should include consideration of how to better incorporate activities into workflow, and may benefit from more consistent use of some of the more underutilized processes including patient inclusion in discharge planning and increased utilization of community supports. Although all facilities had inpatient social workers and/or dedicated case managers working on transitions, many had none or limited true bridging personnel (following the patient from inpatient to home and even providing home visits). More investment in these roles may also be needed.
ABEL Julian, et al
Background: Reducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital. Aim: To evaluate a population health complex intervention of an enhanced model of primary care and compassionate communities on population health improvement and reduction of emergency admissions to hospital. Design and setting: A cohort retrospective study of a complex intervention on all emergency admissions in Frome Medical Practice, Somerset, compared with the remainder of Somerset, from April 2013 to December 2017. Method: Patients were identified using broad criteria, including anyone giving cause for concern. Patient-centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% confidence interval [CI] = 2.8 to 13.1, P = 0.006), in unplanned hospital admissions across the whole population of Frome during the study period from April 2013 to December 2017, a decrease of 14.0%. At the same time, there was a 28.5% increase in admissions per quarter within Somerset, with a rise in the number of unplanned admissions of 236 per quarter (95% CI = 152 to 320, P<0.001). Conclusion The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital, with a decrease in healthcare costs across the whole population of Frome.
STEVENTON Adam, BARDSLEY Martin
The impact of telehealth on hospital use, patient admission and mortality were evaluated in three trial sites in England. The sites were from the Department of Health’s Whole System Demonstrator pilots. The evaluation focused on the use of telehealth to people with chronic obstructive pulmonary disease, diabetes or heart failure. It used a large randomised controlled trial which included over 3,000 participants (1,584 control and 1,570 intervention) in which groups of patients either received the telehealth intervention or acted as controls by receiving their usual care. Statistically significant differences in rates of emergency hospital admission and mortality were found during the twelve months of the trial between control and intervention groups. For intervention patients, the overall costs of hospital care (including emergency admissions, elective admissions and outpatient attendances) were £188 per patient less than those for controls. However, this cost difference was not statistically significant. As well as summarising the main findings the research summary highlights the limitations of the research and other issues that need to be considered in relation to the findings.
COFFEY Alice, et al
Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.
HEALTHCARE INSPECTORATE WALES
Based on a review of integrated care for older people who are at risk of experiencing a fall in Wales, this report highlights learning for staff and for health and social care managers. It focuses on services to help people avoid a fall and how to support people who have had a fall, providing examples of desirable and undesirable pathways through the health and care system. It focuses on the three areas: prevention of falls and promotion of independence, for people living in their own home or in a care home; response to falls when they happen in the community, either for someone living at home or in a care home; and following attendance at hospital due to a fall. It also highlights key themes identified from the review and how the affected service users, service providers and commissioners. The review identified examples of good practice but also found a lack of co-ordination and communication between health, social care and voluntary services could often be a barrier to delivering good quality care. The report has been informed by evidence from six individual falls services, the views of staff and older people. It makes eight recommendations for the Welsh Government, health boards and local authorities. The include a National Falls Framework for Wales, to standardise the approach to preventing, treating and reabling older people who are at risk of falling or have already fallen The report will be relevant for service providers, commissioners and service users.
DAYSON Chris, BASHIR Nadia, LEATHER David
An independent evaluation of the pilot extension of the Age UK Rotherham (AUKR) Hospital Aftercare Service (HAS, into the Emergency Department and Assessment Medical Unit of The Rotherham Foundation Trust Hospital. The pilot, funded by the Clinical Commissioning Group (CCG), ran from 1st October 2017 to 30th September 2018. The evaluation looks at outcomes, focussing on the impact of the service on avoidable hospital admissions, patient experience and independence. It reports that the pilot service provided support to 239 older people who would otherwise have been admitted, offering transport to return home where safe to do so, help and support to settle back in at home and support to access other forms of community based support to enable them to continue to live independently. The findings of the evaluation were overwhelmingly positive. Outcomes achieved include: the prevention of 20 in-patient admissions resulting in the avoidance of £32,180 (estimated) in NHS costs; the provision of additional support in their home to 55 HAS patients and access additional benefits entitlements with a total value of £22,243.55; and reduced waiting times for patient prior to discharge and an improved flow through UECC. Both patients and staff were very positive about the service. The evaluation estimates that overall the pilot led to total benefits (to health services and to patients) of £65,704, a return on investment of 73 pence (£0.73) for each pound (£) invested by the CCG.
NIHR DISSEMINATION CENTRE
This review looks at the concept of 'frailty' in older people and what can be done to raise awareness amongst hospital staff, so that they can better identify and manage the needs of this ‘frail’ older people. It features 53 completed and ongoing studies funded by the National Institute of Health Research. The review covers four key aspects of caring for older people living with frailty in hospital: assessment; identifying and managing symptoms associated with frailty in hospital; discharge planning; and caring environments which consider the context in which inpatient diagnosis and treatment is delivered. The review highlights promising evaluations of workplace training and interventions. It also identifies a number of tools, such as the Frailty Index, that can help hospital staff to identify the severity of needs and help to provide targeted support. It also finds good evidence that the Comprehensive Geriatric Assessment (CGA) is a reliable way of diagnosing and meeting the needs of older people with input from multi-disciplinary teams. It also identifies areas where more research is needed, which include: maintaining activities of daily living for people admitted to hospital; and the effectiveness and cost-effectiveness of different models of delivering care. The review also includes a series of questions that hospital boards, staff and families can ask about the care of older people with frailty in hospitals. Summaries of the 53 studies are also included.
COPEMAN Ian, EDWARDS Margaret, PORTEUS Jeremy, HOUSING LEARNING AND IMPROVEMENT NETWORK
This report shows how housing services are helping to relieve pressure on the NHS by reducing delays in discharging people from hospital and preventing unnecessary hospital admissions. It features 12 case studies to show the positive impact these services have on people’s lives and the cost benefit to the NHS. The case studies highlight services that will benefit people most at risk of delayed discharge, such as older people, people with mental health problems and people experiencing homelessness. The case studies also demonstrate a diversity of housing and health services including: 'step down' bed services for people coming out of hospital who cannot return to their own home immediately; hospital discharge support and housing adaptation services to enable timely and appropriate transfers out of hospital and back to patients' existing homes; providing a new home for people whose existing home or lack of housing mean that they have nowhere suitable to be discharged to; and Home from Hospital services to keeping people well at home who would otherwise be at risk of being admitted or readmitted to hospital. The report also considers the impact and additional savings that could be made by housing providers if this work were to be scaled up.
DAMERY Sarah, FLANAGAN Sarah, COMBES Gill
Objective: To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity.
Design: Umbrella review of systematic reviews and meta-analyses.
Setting: Interventions must have delivered care crossing the boundary between at least two health and/or social care settings.
Participants: Adult patients with one or more chronic diseases.
Data sources: MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database,DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references.
Outcome measures: Any measure of hospital admission or readmission, length of stay (LoS), accident and emergency use, healthcare costs.
Results: 50 reviews were included. Interventions focused on case management (n=8), chronic care model (CCM) (n=9), discharge management (n=15), complex interventions (n=3), multidisciplinary teams (MDT) (n=10) and self-management (n=5). 29 reviews
reported statistically significant improvements in at least one outcome. 11/21 reviews reported significantly reduced emergency admissions (15–50%); 11/24 showed significant reductions in all-cause (10–30%) or condition-specific (15–50%) readmissions; 9/16 reported LoS reductions of 1–7 days and 4/9 showed significantly lower A&E use (30–40%). 10/25 reviews reported significant cost reductions but provided little robust evidence. Effective interventions included discharge management with post-discharge support, MDT care with teams that include condition-specific expertise, specialist nurses and/or pharmacists and self-management as an adjunct to broader interventions. Interventions were most effective when targeting single conditions such as heart failure, and when care was provided in patients’ homes.
Conclusions: Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy, questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity.
ROYAL COLLEGE OF GENERAL PRACTITIONERS, BRITISH GERIATRICS SOCIETY
Joint report showing how GPs and geriatricians are collaborating to design innovative schemes to improve the provision of integrated care for older people with frailty. The report highlights 13 case studies from across the UK which show what an integrated health and social care system looks like in practice and the positive impact it can have. The case studies are grouped into three areas: schemes to help older people remain active and independent, extending primary and community support to provide better services in the community, and integrated care to support patients in hospital. The examples cover a range of locations across the UK, including urban and rural populations, and a range of settings, including services based in the community, in GP practices, in care homes and in hospitals. Whilst the majority of the initiatives led by GPs or geriatricians, they illustrate the vital role that many other professionals play, including nurses, therapists, pharmacists and social workers. The report also outlines some common themes from the case studies, which include person-centred care, multidisciplinary working, taking a proactive approach and making use of resources in the community.
Results 1 - 10 of 21