Trends in emergency admissions

Jones, Rod

doi:10.12968/bjhc.2009.15.4.41722

Cited by 49 publications

(37 citation statements)

References 11 publications

(11 reference statements)

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“…Such beliefs will undoubtedly influence perceptions of appropriate service organisation, an issue reflected in the lack of consensus on how to improve the system. In this context, it is worth noting that the assumptions about avoidable admissions underlying current policy and practice, whilst largely accepted as plausible by professionals, were more likely to be questioned by those with expertise in care of older people (Walsh et al, 2008;Jones, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…Ill-defined conditions provide a useful model for understanding avoidable admissions (Wanless et al, 2007;Walsh et al, 2008;Jones, 2009). These admissions 1 are rising rapidly in older people, account for a substantial proportion of unplanned medical admissions internationally (Walsh et al, 2007(Walsh et al, , 2011Condelius et al, 2008) and are associated with adverse outcomes (Hastings et al, 2009), ambulatory care sensitive conditions (Purdy et al, 2009), admission to nursing homes (van Rensbergen & Nawrot, 2010) and high service use (Condelius et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

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Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways

Walsh

Lattimer

Wintrup

et al. 2014

Int J Older People Nursing

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Background. There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions. Objectives. To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions. Design. A qualitative framework analysis of interview data from a System dynamics (SD) modelling study. Methods. Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis. Results. Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign. Conclusions. Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or © 2014 John Wiley & Sons Ltd 1 specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system. Implications for practice. Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs.Key words: admission avoidance, frailty, framework analysis, hospital admissions, older people, system dynamics modelling What does this research add to existing knowledge in gerontology?• Professionals' assumptions about patient needs and service development were not shared across professional groups and services.• Although professionals acknowledged the need for whole-system service redesign, this study revealed that professionals had only a partial understanding of the whole admissions system.• Lack of expertise in care of older people was seen as a systemwide limitation on development and delivery of admission avoidance services.What are the implications of this new knowledge for nursing care with older people?• The nursing profession must consider how expertise and leadership in care of older people can be developed across the healthcare system.• Nurses with expertise in care of older people to disseminate and develop effective interventions which acknowledge the specific needs of frail older ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways

Walsh

Lattimer

Wintrup

et al. 2014

Int J Older People Nursing

View full text Add to dashboard Cite

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“…Hence average LOS will have upper and lower confidence intervals (which in practice are quite wide but never calculated) and more importantly can fluctuate in unexpected ways over time especially when large numbers of zero day stay 'admissions' are included as a confounding factor. These issues were discussed in part one of this series (Jones 2009a). An alternative approach based on trends in actual bed days per se was concluded to offer far greater certainty in the forecasting of future bed requirements and a detailed discussion of all the technical issues has been given in these publications (Jones 2002(Jones , 2003.…”

Section: Bed Planningmentioning

confidence: 99%

“…The crux of the problem was highlighted in part one of this series. Hospitals are totally unable to flexibly allocate resources in an efficient manner in the absence of an external source of weather-related health forecasts (Jones 2009a). Expecting them to be able to do so is to expect the impossible.…”

Section: Figure 2: Daily Medical Bed Demand At a Large Acute Hospitalmentioning

confidence: 99%

Emergency admissions and hospital beds

Jones

2009

British Journal of Healthcare Management

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Key Points• The method currently used to forecast the number of beds for emergency admissions is flawed and underestimates the real bed requirement • An extended time series of total bed days should be used to estimate future bed requirements • Even in the most length of stay efficient hospitals the size of the medical bed pool has increased over time • The average occupancy applicable to hospitals depends on their size and is higher for larger hospitals • However for the purpose of infection control the maximum average occupancy may be limited to 85%. • Hence any specialty or bed pool with less than 100 beds will operate at an average occupancy less than 85%. • The introduction of single sex wards during 2009/10 may lead to serious operational problems if the size of the bed pool is not increased. AbstractParts one and two of this series discussed the component parts of various trends and longerterm cycles leading to increasing emergency admissions. In this final part of the series the issues around bed planning for emergency admission are discussed in the light of the annual summer/winter and long-term cycles. Provision for zero day and other short stay admissions is also discussed.

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“…Urinary infections cause increased morbidity and mortality in the older population and are a major source of distress, discomfort and negative impact on quality of life 7,8 . Furthermore, for care home residents, UTI is associated with a number of serious potential consequences including increased rates of falls, delirium, emergency admissions to DRInK-Up to prevent UTI in care homes hospital and an associated increased risk of death 9,10 .…”

Section: Introductionmentioning

confidence: 99%

Evaluating a hydration intervention (DRInK Up) to prevent urinary tract infection in care home residents: A mixed methods exploratory study

Booth¹,

Agnew²

2019

JFSF

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Objectives: To investigate potential effects and acceptability of a theoretically driven hydration intervention (DRInK-Up), on the prevalence of urinary tract infections (UTIs), falls and emergency admissions in care home residents. Methods: A single group pre-post evaluation design to test the DRInK-Up intervention, to increase fluid intake by 200-400ml daily. The number of UTIs, falls and emergency hospital admissions for each resident recorded over the DRInK-Up intervention period were compared to rates in the 24 weeks prior. A qualitative investigation of experiences of DRInK-Up was undertaken using focus group interviews with care home staff to determine acceptability. Results: 24 care home residents took part in the intervention. There was a clinically meaningful, but non-statistically significant reduction in number of treated UTIs during the intervention period from 51 UTIs pre-DRInK-Up to 37 post-DRInK-Up (t= .498, 18df, p=0.625). The volume of fluid intake recorded was not correlated with number of UTIs (r= 0.103, p=.676). Falls reported dropped from 52 pre-to 28 post-intervention (t=3.148, df 19, p=0.005). Emergency admissions did not change. Focus group interviews suggested goal setting was uncommon and took the form of externally generated targets for fluid intake rather than negotiated goals. Barriers to increasing fluid intake included resident-related factors or arose from the care home context. A range of facilitators included verbal persuasion, praise and reward. Conclusion: The DRInK-Up study provides preliminary evidence suggesting that increasing daily fluid intake by small amounts may have a potentially positive effect on number of UTIs experienced and number of falls in frail older care home residents. Further research is needed.

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Trends in emergency admissions

Cited by 49 publications

References 11 publications

Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways

Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways

Emergency admissions and hospital beds

Evaluating a hydration intervention (DRInK Up) to prevent urinary tract infection in care home residents: A mixed methods exploratory study

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