Reducing avoidable emergency admissions

This healthcare insight report details an extensive analysis of avoidable emergency admissions over a five-year period, and in doing so highlights a number of actions that can be taken towards preventing them | Dr Foster

This report looks specifically at ambulatory care sensitive conditions (ACSCs), which can be managed or prevented through effective primary and community care. ACSCs can be chronic conditions where early intervention can help prevent exacerbation; acute conditions where early intervention can prevent progression; or conditions where immunisation can prevent disease.

The report paints a startling picture of avoidable emergency admissions, finding that the admission rate increased by nine per cent over the analysis period, even after adjusting for population growth.

The report reveals which conditions patients are most likely to be admitted for in an emergency, who those patients may be, and the impact of deprivation. It takes an in-depth look at the possible savings to be made across both sustainable transformation partnerships (STPs) and clinical commissioning groups (CCGs) in England, estimating combined potential savings of £125 million.

Full report: Reducing avoidable emergency admissions. Analysis of the impact of ambulatory care sensitive conditions in England.

Falls specialist response vehicle

NHS Improvement | October 2018 | Falls specialist response vehicle

An innovative approach to the winter pressures faced by ambulance crews  involved establishing a specialist vehicle service responding to callouts for falls at home.

The service was  trialled in the London Ambulance Service (LAS)  and North East London NHS Foundation  Trust in 2017/18 to set up a specialist vehicle service responding to callouts for falls at home. The he case study outlines the steps taken in response to frail older people making calls to 999, which meant ambulances were unable to attend the highest acuity calls, patient flow through ED was reduced and hospital beds were occupied unnecessarily.



Key outcomes from the specialist vehicle service

  • 1,376 patients were attended
  • 960 were safely kept at home
  • 768 bed days were released (based on 80% of patients staying one night)
  • £173,760 was saved (based on £181 per person cost of A&E attendance)

Read the full details of the case study at NHS Improvement 


The impact of integrated care teams on hospital use in North East Hampshire and Farnham

Health Foundation

This briefing examines the early effects on hospital use of introducing multidisciplinary integrated care teams (ICTs) in North East Hampshire and Farnham (NEHF). It presents the findings of an evaluation conducted by the Improvement Analytics Unit, a partnership between NHS England and the Health Foundation.

  • The analysis shows that during the first 23 months of the programme’s implementation, patients referred to the ICTs attended A&E more frequently, and were admitted as an emergency more often, than the control group. This may be because the ICTs identified urgent unmet need amongst their patients or it may be that more time was needed for the benefits of ICTs on hospital use to be seen.
  • In conclusion, a reduction in emergency hospital use may not be an appropriate objective for these type of multidisciplinary teams, at least in their early stages. Reducing emergency hospital use was only one of the objectives for ICTs in NEHF.
  • There is evidence to suggest that the value of ICTs might lie in their potential to improve patients’ health, health confidence, experience of care and quality of life.

The role of ambulance services in transforming care

What role are ambulance services playing in transforming health and care services in England? | NHS Confederation

This podcast – produced in partnership with the Association of Ambulance Chief Executives – explores their role in detail, providing perspectives from a panel of local and national ambulance service leaders.

The wide-ranging conversation, led by the NHS Confederation’s Phil McCarvill, discusses how ambulance services have adapted ways of working to meet the needs of the evolving health and social care landscape.

Shedding light on the unique position of these trusts, the 12-minute episode also considers the workforce opportunities and risks of transformation, approaches to partnership working, and why ambulance services must be firmly at the decision-making table.

Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions

Health Foundation, 2018

This briefing summarises research that explores the link between how well patients feel able to manage their long-term conditions such as asthma, diabetes and depression and their use of health

The findings show the NHS could reduce avoidable health care use and improve people’s quality of life, if they were better supported to manage their long-term conditions.

The briefing points to solutions and calls for national policy makers and the local NHS to take action now, including by prioritising support for self-management in the NHS long-term plan.

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

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.


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