Author Interviews, Cost of Health Care, Emergency Care / 30.01.2016
Avoidable Acute Admissions From Emergency Room Driven By Time and Space Pressures
MedicalResearch.com Interview with:
Jonathan Pinkney MD FRCP
Professor of Medicine
Plymouth University and Peninsula Schools of Medicine and Dentistry
Centre for Clinical Trials and Population Studies
Plymouth Science Park Phase 1
Honorary Consultant Physician Diabetes and Endocrinology
University Medicine Derriford Hospital
Plymouth Hospitals NHS Trust
Plymouth UK
Medical Research: What is the background for this study?
Dr. Pinkney: The background is that the study was funded by the National Institute for Health Research in response to a call for research on the problem of unscheduled emergency admissions to hospitals in the UK. The rates of patient attendance at emergency departments and subsequent acute admissions to hospitals have risen year on year. Rising numbers of admissions have significant knock-on effects for acute hospitals including crowding in emergency departments, pressures on staffing, and disruption of elective treatment because of high rates of bed occupancy. The increase in admissions has been associated largely with increased short stay admissions. As a result, there has been an increasing view that a significant proportion of acute medical admissions may not be necessary, and in this respect may be said to be avoidable. There had been relatively limited research on how hospitals can best reduce these avoidable admissions.
The main aims of the study were to investigate how senior staff in four major acute hospitals in south west England endeavour to avoid unnecessary acute admissions, and to examine a range of different systems in place in different hospitals to avoid unnecessary admissions. We called this project the "3A" or Avoidable Acute Admissions study. The 3A study was a mixed methods study with a strong emphasis on the narrative experience of patients, carers and healthcare professionals in the emergency departments and associated units of these four acute hospitals. The quantitative component of the study was an application of Value Stream Mapping (VSM), a technique from lean theory, and this was used to identify and measure points of delay in the patient journey.
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