Avoidable acute hospital admissions in older people

Abstract

Understanding avoidable admissions in older people is a pressing issue, with budget restraint, an ageing population and demand for care close to home. To inform local efforts to reduce avoidable admissions in older people we audited a series of acutely ill older people admitted under the local elderly care team. Those admissions that appeared ‘avoidable’ on the ward round were scrutinised in more depth: review of medical notes, patient/carer interview, and primary care provider (GP or community nurse) interview. The information from this process was presented to a GP-consultant panel to judge whether the admission was avoidable. Admissions considered avoidable were classified into one of seven themes. Between 20.6% (27/131) and 32.0% (42/131) of admissions to elderly care were considered potentially avoidable. The findings suggest that avoidable admissions do not just represent a simple failure to manage long-term conditions, but depend on high quality clinical decision making around the time of admission as well as having sufficient capacity in alternative community services.