MedicalResearch: What is the background for this study?
Dr. Gillani: NHS is facing the greatest challenge of its history in the form of A&E pressures and bed availabilities. Unplanned admissions are considered one of the key reasons. With an aging population, multiple co-morbidities and increasing pressures on social and primary care, we need to develop a proactive strategy to deal with this situation. It is a high priority agenda for the DOH. Initiatives such as “named GP for over 75” and “directly enhanced services to avoid unplanned admissions” have been rolled out by DOH in the last 2 years. In order to find an innovative way to assist in reduction of unplanned admissions, we decided to conduct an audit on all recurrent unplanned admissions with diabetes in the hospital over 12 months period. Its objective was to determine any unmet patient needs during an index admission to explore potential of changes in the service and to utilize available resources more effectively in an attempt to prevent next hospital admission for that patient.
MedicalResearch: What are the main findings?
Dr. Gillani: People who are having ≥3 non elective admissions in the hospital are elderly, have multiple co-morbidities and varied reasons for admissions. Only a minority of these patients were admitted due to diabetes related issues and most of these admissions were avoidable. Concepts of “avoidability” and “justification” are used to determine whether admission was potentially preventable with a suitable, proactive prior intervention. Due to multi morbidity in these patients a holistic patient centric care is required that reflects the need of dialectologists to be as skilled general physicians to meet patients’ needs.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Gillani: For clinicians, there is a need to consider unmet needs of the patients at each discharge and to promote and practice holistic rather than gluco-centric medicine. Communication with various agencies like primary and social care to help people cope better at home and to intervene at an early stage of the illness can help avoid unplanned admissions. This requires an integrated model of care delivery across NHS boundaries.
For patients, it may be re-assuring to know that NHS is trying its best to provide better care and finding more effective way to improve patient experience during their time of illness.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Gillani: We need to conduct a research trial to evaluate the impact of proactive intervention during an index admission of the patients who have recurrent non elective admissions. This will be a prospective study to address unmet patient needs and to design a methodology to do an early intervention in an appropriate setting across primary and specialist services in an attempt to prevent the next unplanned admissions. There is a lack of evidence base in this arena and we would encourage people to conduct more trials in this field of medicine.