How to reduce unplanned hospital admissions

Unplanned admissions account for approximately 40% of hospital admissions in England. They can challenge health services due to being costly, disruptive, and likely to increase waiting lists and therefore waiting times for scheduled treatments.

Recent research led by academics at Bristol University together with NHS Bristol has evaluated several key interventions designed to reduce unplanned admissions. The researchers evaluated the effectiveness and cost-effectiveness of thirteen interventions to assess which were successful in the reduction of unplanned admission or re-admission to a secondary care acute hospital.

Using data from 274 studies, a systematic literature review was carried out. It considered interventions such as:

• Case management
• Specialist clinics
• Community interventions such as home visits
• Systematic reviews for patients
• Medication reviews
• Education and self management
• Exercise and rehabilitation
• Telemedicine
• Vaccine programmes, and
• "Hospital-at-home" following early discharge.

The outcome of the study indicates that education and self management, exercise and rehabilitation and telemedicine in selected patient populations, and specialist heart failure interventions can help reduce unplanned admissions by up to 60%. However, the evidence to date suggests that the majority of the remaining interventions included in this analysis do not help reduce unplanned admissions in a wide range of patients.

Dr Sarah Purdy, lead researcher from Bristol's School of Social and Community Medicine, said:

" The results of this research are important for policy makers, clinicians and researchers as few studies include evaluation of system-wide approaches.
_ The research shows which of the interventions are more effective. Some interventions that are shown to have no impact on rates of unplanned hospital admission may have impact in other areas, for example case management appears to reduce length of hospital stay."

Deborah Evans, the Chief Executive of NHS Bristol, added:

" These findings are significant for the NHS as they highlight the importance of robust evaluation of interventions and we welcome having evidence of which interventions reduce unplanned hospital admissions which are often distressing for patients. We have to balance this against other interventions, which might not affect unplanned admissions, such as patients being allowed to go home from hospital with help which often helps their recovery."

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