Results for 'hospital admission'
Results 1 - 10 of 18
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.
This is one of a series of quick, online guides providing practical tips and case studies to support health and care systems. It provides practical resources and information for Clinical Commissioning Groups (CCGs) from a range of national and local organisations on how housing and health can work together to prevent and reduce hospital admissions, length of stay, delayed discharge, readmission rates and ultimately improve outcomes. Specifically, the guide describes: how housing can help prevent people from being admitted to hospital – by enabling access to home interventions (social prescribing), improving affordable warm homes (safe, warm housing), improving suitability and accessibility, and providing housing support; how housing can help people be discharged from hospital – through coordination of services, provision of step down services, and accessible housing design; and how housing can support people to remain independent in the community – by enabling informed decisions about home and housing options, providing assistive technology and community equipment, supporting social inclusion, providing supported housing, and promoting healthy lifestyles.
GEORGHIOU Theo, et al
Presents the findings of an evaluation of seven social action projects funded by the Cabinet Office, NHS England, Monitor, NHS Trust Development Authority and the Association of Directors of Adult Social Services. The aim of the Reducing Winter Pressures Fund was to scale up and test projects that used volunteers to support older people to stay well, manage health conditions or recover after illness, and thereby reduce pressure on hospitals. The organisations supported by the fund comprised a range of national and local charities. These projects fell into three broad categories: community-based support, supporting discharge from hospital wards, and supporting individuals in A&E department to avoid admissions. Between them, the projects offered a wide range of services to older people – both direct (for example help with shopping or providing transport) and indirect (linking with other services). The evaluation resulted in a mixed set of findings. From the interviews with staff, volunteers and local stakeholders, there was evidence of services that had made an impact by providing practical help, reassurance and connection with other services that could reduce isolation and enable independence. Those involved with the projects felt that volunteers and project staff could offer more time to users than pressurised statutory sector staff, which enabled a fuller understanding of a person’s needs while also freeing up staff time. However, the analysis of hospital activity data in the months that followed people's referral into the projects did not suggest that these schemes impacted on the use of NHS services in the way that was assumed, with no evidence of a reduction in emergency hospital admissions, or in costs of hospital care following referral to the social action projects. The one exception was the project based in an A&E department, which revealed a smaller number of admissions in the short term. The report questions whether these sorts of interventions can ever be fully captured solely using hospital-based data and conceptualising reduced or shortened admissions as a key marker of success.
DAYSON Chris, BASHIR Nadia
Provides a detailed assessment of the social and economic impact of the Rotherham Social Prescribing Pilot from the perspective of key stakeholders. Social prescribing provides a way of linking patients in primary care and their carers with nonmedical sources of support within the community. Over the course of the pilot: 24 voluntary and community organisations (VCOs) received grants with a total value of just over £600,000 to deliver a menu of 31 separate social prescribing services; 1,607 patients were referred to the service, of whom 1,118 were referred on to funded VCS services; the five most common types of funded services referred to were information and advice, community activity, physical activities, befriending and enabling. The evaluation looked at the impact on the demand for hospital care and the economic and social benefits. The findings demonstrate that economic and social outcomes have been created for three main stakeholder groups: patients with LTCs and their carers, who have experienced improved mental health and greater engagement with the community; the local public sector, in particular health bodies, which have benefited from the reduced use of hospital resources; and the local voluntary and community sector, which has benefited from a catalytic investment in community level service provision.
Results 1 - 10 of 18