REVIEW ARTICLE

Avoiding Hospital Admissions

- What does the research say?
The Kings Fund, Ideas that change health care
by Sarah Purdy
December 2010
AGUSTINUS VINCENT
M A D E D W I P E RT I W I
NADA YULIANDHA
K E PA N I T E R A A N K L I N I K I L M U P E N YA K I T D A L A M
R S T I N G K A T I I K A R T I K A H U S A D A , K U B U R AYA
2016

ebimbing ; dr. Iqbal Lahmadi, Sp. PD

Introduction
Hospital
admission

NHS is
avoiding
hospital
admission or
unplanned

Emergency
admission
That are not predicted
and happen at short
notice because of
perceived clinical need,
NHS 2010
Represent 65% of hospital
bed days in England
-) rising unit costs compared to
other care
-) disruption : inpatient waiting
list

Aims
What interventions work in reducing
avoidable admissions?
Who is at risk, and how do we identify them?
Which admissions are potentially avoidable?
Which interventions work in:
primary care
social care
emergency care
discharge from hospital

Who is at risk of emergency

admission?
Age

Who is at risk of emergency

admission?
How do we identify those at risk?

Interventions to reduce hospital

admission
Self
manageme
nt
Interventio
ns in
primary
care
Telemedicin
e

Case
manageme
nt

Barlow et al. 2007, the most effective

telecare interventions appear to be
automated vital signs monitoring and
telephone followup
-) Some studies : beneficial to advocate
patient with risks, management, related to
his/her chronic illness. Best with nurses
supportive care
-) Nurses supportive care takes more costs
-) there are pros and cones

Interventions in hospital
reducing re-admission
Admitted
frequently

> 3 times
admitted ->
programme
d as
outpatient

Hospitalbased case
management

Discharge
from
hospital

-) reduced
6% readmission
-) no benefits

Shepperd, 2010 :
-) Strong evidence only
comes from structured
inpatient discharge
planning
-) reduced about 15%
of re-admission

Conclusion & recommendations

(page 1)
National policy-makers should:
1. encourage commissioners to implement evidencebased interventions for avoidable admissions, and
to evaluate their impact in the local context
2. consider the impact of socio-economic deprivation
and other socio-demographic factors when
designing policy around admission rates
3. aim to increase self-management among people
with long-term conditions where there is evidence
of benefit.

Conclusion & recommendations

(page 2)
Hospital providers and commissioners should:
1. be clear about which admissions they
consider to be avoidable, what proportion of
these admissions are avoidable, and how
these admissions should be coded and
measured
2. Implement evidence-based interventions as
follows:
multidisciplinary interventions and
telemonitoring for patients with heart failure
and assertive case management for patients
with mental health problems
hospital at home
closer integration of primary and

Conclusion & recommendations

(page 3)
3. continue to implement acute assessment
units, but consider the overall impact on
number of admissions
4. aim to increase self-management among
people with long-term conditions where
there is evidence of benefit.
In addition, commissioners should:
5. disinvest in programmes where there is
robust evidence that they have little or no
effect
6. evaluate all new interventions, as even
those that have proved beneficial in other
settings may not be transferable to the

Conclusion & recommendations

(page 4)
1.
2.

3.

4.

Primary care providers should:

aim to increase continuity of care with a GP
consider the impact of local, out-of-hours
primary care arrangements on avoidable
admissions
consider closer integration of primary and
social care, evaluating the outcomes of any
new interventions
consider closer integration of primary and
secondary care, evaluating the outcomes of
any new interventions.

Thank you