Emergency admissions to hospitals have risen annually, exacerbating pressures on emergency departments (EDs) and acute medical admission units (MAUs). These pressures can adversely impact patient experience through overcrowding and potentially suboptimal clinical decision-making. Solutions proposed to meet demands for emergency care include: development of new units linked to emergency departments, earlier senior input, and hospital-based teams to support discharge. However, the cumulative effect of these alternative care models, on patient and clinician experience, has not been fully investigated.
The NIHR HS&DR funded the Avoidable Acute Admissions project (2012-14) to investigate how clinician expertise and decision-making in four hospitals in south-west England contributed to safely reducing acute admissions.
The project used a mixed-methods case study design for a comparative analysis of decision-making about admissions in four acute hospitals in south-west England. The primary research comprised two parts: value stream mapping (VSM) to measure time spent by practitioners on key activities in 108 patient pathways, including an embedded study of cost; and an ethnographic study incorporating data from 65 patients, 30 carers, and 282 practitioners of different specialties and levels.
Additional data was collected through a clinical panel, learning sets, stakeholder workshops, reading groups and review of site data and documentation. We used a realist synthesis approach to integrate findings from all sources.
This project is supported by the NIHR ARC South West Peninsula (PenARC).