With our hospitals on high levels of alert and seemingly insurmountable pressures on the rest of the NHS and social care networks, now more than ever before the question is being asked: “what next for our NHS?”.
The issues faced by our health and social care services are as complex as they are unprecedented. But the situation is not wholly hopeless – while there is no one ‘magic bullet’ to solve the current crisis and cut future crises off at the pass, there are solutions which have been shown to be effective when properly implemented.
Last year we published the findings of a study which investigated how hospitals try to avoid unnecessary emergency admissions, the primary cause of non-essential stays in hospital. The study identified a series of innovations that can help to address this pressing problem in different ways
In recent months, an increasing number of hospitals have been put on level five alerts as pressures from emergency admissions have serious repercussions for bed occupancy and planned (elective) treatments.
There is evidence that a significant proportion of acute hospital admissions are avoidable, and hospitals across the country have introduced a range of innovative initiatives to try to avoid these unnecessary admissions. Until we carried out our study there had been no research to investigate how well such measures work in practice and whether they meet the needs of patients.
The research team, led by us at Plymouth University and including experts from the University of the West of England, University of Bristol, and the University of Exeter, investigated how the emergency departments and staff of four major hospitals (Bath, Exeter, Gloucester and Plymouth) responded to emergency care pressures and the experiences of their patients. We published our findings in the Health Services and Delivery Research journal.
The research was funded by the NIHR Health Services and Delivery programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC).
We found that the likelihood of a decision being made to admit a patient to hospital was not determined solely by the medical diagnosis and perceived risk: it was also influenced by the seniority and experience of the clinical staff making the decisions, the patient’s social circumstances, access to certain investigations, the proximity of the four-hour target and the availability of time to arrange alternatives to hospital admission where these existed.