Avoidable emergency admissions (AEAs) AEAs Ambulatory Care - - PowerPoint PPT Presentation

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Mar 30, 2024 347 likes •540 views

Avoidable emergency admissions (AEAs) AEAs Ambulatory Care Sensitive Conditions (ACSC). Diagnoses for which effective care can reduce admissions. Acute conditions not usually requiring admission. 15- 20% of emergency admissions are avoidable.

SLIDE 1

Avoidable emergency admissions (AEAs)

SLIDE 2

AEAs

Ambulatory Care Sensitive Conditions (ACSC).

Diagnoses for which effective care can reduce admissions.

Acute conditions not usually requiring admission. 15- 20% of emergency admissions are avoidable. GP referrals account for 8.5% of all attendances (National data).

SLIDE 3

ACSCs

COPD AF Asthma Diabetes Convulsions Iron deficiency anaemia

CCF Dementia Angina Hypertension Vaccine preventable

Flu, pneumonia

SLIDE 4

Avoidable acute problems

Pyelonephritis UTI Flu Pneumonia Gastroenteritis LRTI in children

ENT infections Convulsions Perforated PU Cellulitis Dental conditions

SLIDE 5

Richmond CCG

12,300 emergency admissions (2012/13). 3rd lowest London (ACSC). 5th lowest London (Acute). 16% seem avoidable. Aim- reduce by 3.5% (479) in 2015/16.

SLIDE 6

Willie Sutton's Law

1901 - 1980 Stole from the rich...... And kept it! $2 million in career. Robbed banks because "that's where the money is. "

SLIDE 7

Kings Fund Myths

A&E wait times have increased. Number going to A&E has increased. Increased A&E attendance is due to reduced GP access. A&E pressures due to inadequate staff/skill mix. Delays discharging from hospital are due to social care problems.

SLIDE 8

A&E attendances

14 million 2003 21.7 million 2013 30% of these attending WICs and minor injuries Type 1 A&E increased 12.6 million to 14.2 million (18%)

SLIDE 9

Who's fault?

Patients GPs Hospitals 111 Immigrants Government Society

SLIDE 10

Table 1

List %>65 Admissions/10,000 Admissions Population >65 Rate per 10,000 pop.>65 7679 11.9 74.2 57 914 624 9492 16.2 83.2 79 1538 514 3854 10 96 37 385 960 6791 17 64.8 44 1154 381 3925 6.9 63.7 25 271 923 8959 8.9 65.9 59 797 740 2973 14.5 137.9 41 431 951 3663 11.1 54.6 20 407 492 13646 14.3 105.5 144 1951 738 8677 14.3 94.5 82 1241 661 10467 12.2 78.3 82 1277 642 3944 14.6 91.3 36 576 625 2031 22.2 157.6 32 451 710 2043 18.2 122.4 25 372 673

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Risk factors

Age

0-4 years
Over 65 years (14% of

population but 57% of admissions. Frailty Comorbidity (50% admissions have 8+) Variation in practices

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Condition Total admissions Lowest Highest UTI 407 7 .3 50.5 Flu & pneumonia 308 4.5 30.3 Gastro + dehydration 197 17 .3 COPD 146 2.3 39.4 AF 123 1.3 13.4 ENT infection 111 1.3 11.2

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What causes avoidable A&E admissions?

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How could we reduce avoidable A&E admissions?

SLIDE 15

What doesn't work?

WICs and minor injury units Community matrons

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What works?

SLIDE 17

COPD

Pathway and EOLC (2009- 2013 2 hr rapid response community service Winter warmth campaign Increased diagnosis (1833- 1976) Emergency admissions 275 to 233.

SLIDE 18

Since implementation of the End of Life Care Strategy in 2008, the percentage of deaths in hospital has decreased

Percentage 0% 25% 50% 75% 100% Year 2008 2009 2010 2011 2012 2013 Home or care home Hospital

Source: Primary Mortality data for Richmond, 2013

SLIDE 19

Emergency admissions by care homes residents

What have we done:
Care home pilot in 4 care homes providing nurse

specialists working with care home staff to proactively identify patients at risk of an unplanned admission to hospital.

Other initiatives include Co-ordinate My Care;

Anticipatory care planning guidance and training; Care home rapid response service; Safety Thermometer; Falls screening and management; Medicines reviews, and; Nutrition guidance

Between 2012/13 and 2013/14, emergency admissions by

care home residents aged 65 years and over reduced from 476 to 444 (by 7%). Mean length of stay also reduced (from 11 days to 10 days).