Emergency hospital admissions in England: which may be avoidable and how?

New research led by the Health Foundation looks at trends in emergency admissions over the past decade and reviews some of the interventions aimed at reducing them.

Key findings:

  • One in three patients admitted to hospital in England as an emergency in 2015/16 had five or more health conditions, such as heart disease, stroke, type 2 diabetes, dehydration, hip fracture or dementia. This is up from one in ten in 2006/07
  • The number of patients admitted urgently to hospital has increased by 42% over the past decade – that’s an average of 3.2% per annum. This far outstrips the total number of people who attend A&E departments, which is up by only 13%
  • Patients arriving at A&E are sicker than ever before, and more likely to need admission. This has grown for patients with multiple health conditions, as well as for older patients aged 85 or over, up by 58.9%
  • Hospitals are treating patients more quickly, with overnight stays for those with five or more conditions lasting 10.8 nights in 2015/16 compared with 15.8 days a decade previously. The number of these patients admitted to hospital but discharged on the same day have increased by 373% over the same period.

The briefing also identifies opportunities to reduce emergency admissions including:

  • Approximately 14% of all emergency admissions are for ‘ambulatory sensitive’ conditions – conditions such as asthma where timely and effective primary care could reduce the likelihood of admission
  • If older patients saw their regular GP two more times out of every ten consultations, this would be associated with a 6% decrease in admissions for ambulatory sensitive conditions
  • Around 26.5% of all unplanned A&E attendances in England (5.77 million per year) were preceded by the patient being unable to obtain a GP appointment that was convenient to them, however few of these A&E attendances will have resulted in an admission.

Full document: Emergency hospital admissions in England: which may be avoidable and how? | The Health Foundation

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Paramedic’s ‘light bulb moment’ saves the NHS more than £2 million

NHS England | May 2018 | Paramedic’s brainwave eases A&E pressures by keeping “frequent callers’ away

A senior  paramedic who noticed that a small number of patients used a lot of NHS resources and staff time came up with the idea to address their problems with an innovative programme. Rhian Monteith arranged a scheme where the frequent callers were able to meet for coffee and a chat.  The scheme The High Intensity User programme was innovated by Rhian who collaborated with other teams to compile  a list of 23 patients, many suffering from mental health problems or loneliness, who had visited A&E more than 700  times during the previous three months, mostly by ambulance. Through personal mentoring and one-to-one coaching, as well as getting them involved with community activities, the patients were encouraged to phone her rather than dial 999.

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Rhian helped A&E attendances, 999 calls and hospital admissions drop by about 90 per cent among the group.  The scheme was then scaled up to cover about 300 patients in Blackpool over the following three years, saving the NHS more than £2million. It has now been rolled out to around a fifth of the country with 36 local heath teams adopting the scheme. (Public Health England)

The full news story is at NHS England 

Allied Health Professions supporting patient flow

This quick guide demonstrates how NHS emergency care, in particular patient flow through the health and care system, benefits from allied health professionals | NHS Improvement

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Bringing the AHP workforce into patient flow planning can improve quality, effectiveness and productivity.

Each section gives a brief overview of the contribution that AHPs have made to deliver safe, effective patient care and flow, followed by case studies which demonstrate how AHPs:

  • work in the community keeping people safe and well at home
  • ‘front door’ assess, diagnose and treat patients in emergency departments, ambulatory care and assessment units
  • support avoidance of hospital admission
  • enable early rehabilitation and reducing overnight admissions
  • drive ‘Home First’ (discharge to assess) to avoid in-hospital deconditioning of frail, older people.

Full detail: Quick guide: allied health professions supporting patient flow

Reducing emergency admissions

This report from the National Audit Office examines progress that the Department of Health, NHS England, NHS Improvement and other stakeholders are making in reducing the impact of emergency admissions on acute hospitals.

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The report looks at action across acute, primary, community and social care systems rather than focusing on A&E departments alone. It builds on the 2013 report on Emergency admissions to hospital: managing the demand and our 2016 report on Discharging older patients from hospital, which also examined the pressures on the whole health and social care system.

  • Part One sets out trends in emergency admissions;
  • Part Two explains NHS England’s and partners’ response to increasing emergency admissions;
  • Part Three assesses the challenges in reducing emergency admissions.

Full report: Reducing Emergency Admissions | National Audit Office

Urgent and emergency care: best practice

This CQC report offers practical examples of how leading emergency departments are meeting the challenges of managing capacity and demand, and managing risks to patient safety .

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This report from the Care Quality Commission details the good practice identified following the Commission’s work with consultants, clinical leads, senior nursing staff and managers from leading emergency departments in 17 NHS acute trusts.

This resource identifies:

  • strategies staff use to meet the challenge of increased demand and manage risks to patient safety
  • positive actions to address potential safety risks and to manage increased demand better
  • how working with others can manage patient flow and ensure patients get the care they need
  • that rising demand pressures in emergency departments are an issue for the whole hospital and local health economy.

Full report: Sharing best practice from clinical leaders in emergency departments

Elevated mortality among weekend hospital admissions is not associated with adoption of seven day clinical standards

Meacock R, Sutton M. Elevated mortality among weekend hospital admissions is not associated with adoption of seven day clinical standards
Emerg Med J Published Online First: 08 November 2017. doi: 10.1136/emermed-2017-206740

Introduction Patients admitted to hospital in an emergency at weekends have been found to experience higher mortality rates than those admitted during the week. The National Health Service (NHS) in England has introduced four priority clinical standards for emergency hospital care with the objective of reducing deaths associated with this ‘weekend effect’. This study aimed to determine whether adoption of these clinical standards is associated with the extent to which weekend mortality is elevated.

Methods We used publicly available data on performance against the four priority clinical standards in 2015 and estimates of Trusts’ weekend effects between 2013/2014 and 2015/2016 for 123 NHS Trusts in England. We examined whether adoption of the priority clinical standards was associated with the extent to which weekend mortality was elevated, and changes over a 3 year period in the extent to which mortality was elevated.

Results Levels of achievement of two of the four clinical standards (ongoing review and access to diagnostic services) had small positive associations with the magnitude of the weekend effect in 2015/2016. Levels of achievement of the remaining two standards (time to first consultant review and access to consultant directed interventions) had small negative associations with the magnitude of the weekend effect in 2015/2016. No association was statistically significant. The same pattern was observed in the associations between achievement of the standards and changes in the magnitudes of the weekend effect between 2013/2014 and 2015/2016.

Discussion
We found no association between Trusts’ performance against any of the four standards and the current magnitude of their weekend effects, or the change in their weekend effects over the past 3 years. These findings cast doubt on whether adoption of seven day clinical standards in the delivery of emergency hospital services will be successful in reducing the weekend effect.