Avoiding hospital admissions: what does the research evidence say?

Emergency admissions represent around 65% of hospital bed days in England. It is a major concern for the NHS, despite considerable efforts to reduce emergency admissions, only a few PCTs succeeded between 2007 and 2009.

The King's Fund has published a paper which considers the research evidence for a range of interventions to avoid emergecy or unplanned hospital admissions addressing the following key questions:
- What interventions work to reducing avoidable admissions?
- Who is at risk and how do we identify them?
- Which admissions are potentially avoidable?
- Which interventions work in primary, secondary and emergency care as well as discharge from hospital?

Some of the findings on interventions in A&E :
- A recent systematic review of the evidence for the effectiveness of GPs working in EDs found that this intervention may result in fewer referrals for admissionn but the evidence is weak.
- A study of a GP service aimed at patients who are referred for urgent medical admission by a GP in the ommunity showed a small reduction in admissions to the medical assessment unit.
- Making a senior emergency medicine clinician available to review patients in the ED has been shown to reduce inpatient admissions by 12 % and specifically reduced admissions to the acute medical assessments unit by 21%.

The paper finds that there is insufficient evidence to support many of the interventions currently being implemented and concludes that policy-makers, providers and commissioners can introduce a number of changes that have proved to be effective in reducing admissions and includes recommendations for all of these groups, emphasising the importance of using evidence-based interventions.

Source: "Avoiding hospital admissions: what does the research evidence say?" King's Fund , Dec 2010