Abstract
BackgroundTo examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). To identify variables predictive of appropriateness and explore management alternatives.MethodsAdults admitted as acute patients to Derby Hospitals NHS Foundation Trust (England). Data were collected prospectively and examined by a multi-disciplinary expert panel to determine the appropriateness of admission and length of stay (LoS). Management alternatives were discussed.ResultsA total of 119 participants were recruited. 32 admissions were inappropriate and 83 were for an inappropriate duration. Whether a participant lived in their own home was predictive of an inappropriate admission. The number of LTNCs, number of presenting complaints and whether the participant lived alone in their own home were predictive of an inappropriate LoS. For admissions judged to be inappropriate, the panel suggested management alternatives.ConclusionPatients with LTNCs are being admitted to hospital when other services, e.g. ambulatory care, are available which could meet their needs. Inefficiencies in hospital procedures, such as discharge planning and patient transfers, continue to exist. Recognition of the need to plan for discharge at admission and to ensure in-patient services are provided in a timely manner may contribute towards improved efficiency.
Highlights
To examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs)
One risk factor for an inappropriate admission, living in your own home compared to a residential/nursing home, was identified and this may relate to the availability of support for those who live in long term care facilities compared to those who live in their own home
Increased availability of social care services, especially 'out of hours', has long been called for and our findings indicate that a number of inappropriate admissions documented in this study could have been avoided if such services had been accessed
Summary
To examine the appropriateness of admissions and in-patient stay for patients with long term neurological conditions (LTNCs). People with long term neurological conditions (LTNCs) sometimes have acute episodes of illness that may necessitate hospital admission. McDonagh, noted when reviewing evidence for a systematic review, that it can be difficult to draw conclusions reliably from existing data, she suggests that the percentage of inappropriate acute hospital bed use for adults, worldwide, lies somewhere between 15% and 50% [9]. The importance of this topic has been reflected in the recent policy agenda. The National Service Framework (NSF) for Long Term (neurological) Conditions, for example, outlines quality requirements for the care and treatment of patients with LTNCs admitted to hospital, and aims to contribute towards the Public Service Agreement target of 'reducing emergency bed days by 5% by 2008 through improved care in primary and community settings for people with long-term conditions' [10]
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