Avoiding hospital admissions: What does the research evidence say?

Emergency admissions to hospital are costly to the NHS and also cause disruption to planned health care.

Considerable efforts have been made within the health service to reduce emergency admissions, but few primary care trusts have been successful, with some primary care trusts recording an increase.

In order to successfully reduce avoidable emergency admissions, we need to fully understand which interventions are the most effective. The King's Fund commissioned this review of research evidence to establish which interventions work in avoiding emergency or unplanned hospital admissions.

This paper aims to address the following questions:

• 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.

The review of available research evidence identified interventions where there is evidence of positive effect on both admissions and re-admissions, those where there is evidence that the intervention has no beneficial effect, and a range of interventions where more evidence is needed to determine whether they have the potential to reduce admissions.

The author emphasises that interventions to reduce emergency admissions take place within a complex environment, in which the nature and structure of existing care services, individual professional attitudes, patient and family preferences, and general attitudes to risk management can affect their implementation. It is also acknowledged that some interventions, although they fail to reduce admissions, may have other beneficial effects, such as reducing length of stay or improving patients' experience of care.

The paper concludes that policy-makers, providers and commissioners can introduce a number of changes that have proved to be effective in reducing admissions and includes recommendations for all of these groups, emphasising the importance of using evidence-based interventions.