Download the appendices for this paper
We have produced information on the length of stay, emergency bed days and emergency admissions for each PCT in England. This information will show PCTs where their organisation ranked with others in our analysis. The emergency bed days per PCT also show where the additional bed savings we have identified exist.
- Older people and emergency bed use: appendices
- Average emergency length of stay for patients over 65, per annum, England PCTs: appendices
- Needs-weighted emergency bed days per person over 65, per annum, England PCTs: appendices
- Needs-weighted emergency admissions per person over 65, per annum, England PCTs: appendices
More on older people and emergency bed use
- Read Candace Imison's blog: Use of emergency hospital beds: why is there so much variation?
- See the press release for this paper: 2.3 million fewer overnight hospital stays needed if all areas perform as well as top 25%
The only headline measure that matters to me is outcome. Protracted lengths of stay in hospital lead to poor outcomes but so do community based diagnosis-avoidance models of care which lead to repeated critical events managed poorly by an overheated emergency care system.
The solution as far as I am concerned is to rebalance and reconnect medical and functional modelling across the older persons health economy
During a seven months pilot, patients at risk of hospital emergency admission or re-admission were admitted in their homes termed as virtual ward. Admission was based on SPARRA-65 data and personal GP practice/consultant physician’s intelligence.
The virtual ward team comprised of a hospital based consultant physician, two GPs, district nurse and GP practice manager. District nurses paid regular visits to patients. A weekly teleconference was held among virtual ward team to discuss patients. GP practice was enabled to upload virtual ward documentation directly into SCI STORE EPR.
There were twenty one admissions. There were no unscheduled admissions of virtual ward patients into the hospital. There was 25% reduction in emergency admissions, 12% in re-admissions and 12-13% in LOS when compared to the same period in the previous year. Patients felt that they benefited from increased nursing input but not all understood the concept of virtual ward. It was a zero finance pilot. Activity was easily accomodated in current working schedule.
Virtual ward provides a new interface between primary and secondary care for improved patient care due to timely and appropriate intervention, more effective communication, & easier clinical decision making. A reduction in hospital emergency admissions, readmissions and LOS was shown.
Now we are rolling out Lochaber Virtual ward care model to more GP practices in the Fort William area with participation of more hospital based consultants.
Any question to which Cornwall, Norfolk and North East Lincolnshire is the answer cannot be the right one.
The corollary of supply induced demand is to question the use of demand repression in rural, under-resourced areas.
I agree with the doctor who says that we should only cut emergency beds after system reforms have improved out of hospital care sufficient for us to see that demand for emergency care is reducing. At present it is still increasing.