accessibility & help

In and out of hospital: how to stop avoidable admissions

 

  

A new British Red Cross report calls for action to stop an ‘endless cycle’ of avoidable hospital admissions among vulnerable patients. This could ease pressure on the health and social care systems.

The study proposes introducing automatic home assessments and other simple interventions for elderly and vulnerable people who are often admitted to hospital.

Currently these people are being sent home without the right support, or to unsuitable or unsafe conditions at home. They are then more likely to end up back in hospital.

The latest figures show that emergency hospital admissions have risen by 22.8% in the last five years. People being readmitted within 48 hours now accounts for one in five of all emergency readmissions.

According to our analysis of first-hand accounts of frontline health and care workers, there are too many missed opportunities to prevent many of these avoidable admissions.

Automatic information and assessment systems would help

One shortfall in the current system is the lack of a consistent flagging mechanism for staff when someone is routinely in and out of hospital.

Automatic home assessments should be triggered for people who have come in and out of hospital several times within a few months. We encounter people who have come in and out of hospital with nobody questioning why their needs have spiralled into something much more complex.

Hospitals are under tremendous pressure but we have identified a number of small practical steps. These could make a big difference both to people and ‘patient flow’, at minimal cost to the health service.

Key recommendations include:

  • The government should invest in non-clinical personnel in A&Es to help prevent people who have no medical needs but need support at home from being admitted.
  • The government should establish more multidisciplinary teams who work with people at risk of being admitted into hospital.
  • Hospitals should ensure all discharge checklists include an assessment of equipment and medication needs, from a wheelchair to blister packs. These should be arranged before leaving hospital.
  • At a minimum, transport home from hospital should be offered to all those who live alone or who are leaving by themselves and have poor mobility. Helping them inside their homes would give an opportunity to check their home environment.
  • When frail patients’ transfer home has been delayed, hospitals should encourage and help them to get dressed and walk around every day so their condition does not deteriorate.
  • People who live alone, have poor mobility and have been in and out of hospital due to falls should automatically have their home assessed for falls hazards before they are discharged.
  • Staff need to know when someone has been in and out of hospital. In such cases, an automatic home assessment is vital. While people might appear to be medically fit enough for discharge, a regular cycle of readmission often signals that something is amiss at home.

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