Most schemes to cut unplanned admissions do not work

Most interventions designed to cut unplanned admissions fail to do so, and only a few techniques focused on specific groups are effective, researchers have found.

Exercise: an intervention found to reduce unplanned and repeated hospital admissions among the elderly (Photograph: Istock)
Exercise: an intervention found to reduce unplanned and repeated hospital admissions among the elderly (Photograph: Istock)

Researchers studied the effectiveness and cost-effectiveness of 13 interventions aimed at reducing unplanned admission or re-admission. The University of Bristol team looked at data from 274 studies.

Most of the techniques they studied were not successful in reducing unplanned admissions in a wide range of patients. These included: case management; specialist clinics; community interventions; medication review; finance schemes; A&E interventions; continuity of care; vaccine programmes; and hospital at home schemes.

However, a handful of initiatives were successful: education and self-management; exercise and rehabilitation; telemedicine in selected populations; and specialist heart failure interventions.

Lead researcher Dr Sarah Purdy said the findings had important implications for policy makers and clinicians. Few previous studies had evaluated system-wide approaches to cutting unplanned admissions, and this latest study showed which interventions were most  effective, she said.

She added: ‘Some interventions that are shown to have no impact on rates of unplanned hospital admission may have an impact in other areas, for example case management appears to reduce length of hospital stay.’

Deborah Evans, chief executive at NHS Bristol, said the findings would be significant for the NHS.

‘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,’ she said.

‘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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