Admission avoidance in UK healthcare: What works and what doesnt? A hermeneutic review

BackgroundAvoidable hospital admissions in the UK have been a focal area for healthcare policy and research, often with a focus on prevention. This is particularly important as hospitalisation can negatively impact patients, especially frail older people, leading to further risk of morbidity and mortality. To reduce costs and enhance patient care, the focus has shifted toward improving community interventions to prevent admissions. Actions to address this issue include the expansion of new types of care, such, for example, virtual wards. However, evidence is lacking on how current initiatives are improving care and which factors lead to emergency admissions which could be avoided in the UK. The aim of this study is to examine and synthesise the current evidence of admissions avoidance in the UK, including understanding how different populations, chronic conditions and social determinants might affect the most the risk of avoidable admissions. From a health services perspective the aim is to understand which types of care and community interventions prevent avoidable admissions. DesignThe published evidence on admission avoidance is voluminous and so a hermeneutic review was undertaken. Results82 papers met the criteria. A dominant theme is the complexity of reducing emergency admissions, emphasising the impact of social determinants, particularly in deprived and older populations. Optimising service delivery, targeting care gaps, and improving care coordination are essential. Managing comorbidities, especially in conditions like ambulatory care-sensitive conditions such as COPD, diabetes, heart failure, cancer and preventing infections, can reduce admissions. Interventions vary in context, style and target with some, particularly those who provide care to high-risk patients and in deprived areas showing success in reducing emergency attendances and improving hospital resource use. ConclusionIn conclusion, preventing avoidable admissions is complex due to the broad range of factors that influence risk of admission, and the multifaceted interventions required, as no single solution fits all neither interventions evaluations are consistent. This complexity should be considered when introducing new services. While shifting care towards the community can offer benefits, this review suggests a more integrated approach--one that bridges acute, hospital, and community care--is necessary to effectively reduce emergency admissions. Key target areas which might offer further opportunities are those populations who are elderly, experience poverty and social deprivation and which have high risk of comorbidities such as ambulatory care-sensitive conditions.