Better integration could cut elderly patient bed days by 2.3 million a year, says King’s Fund

BMJ 2012; 345 doi: (Published 10 August 2012) Cite this as: BMJ 2012;345:e5434
  1. Ingrid Torjesen
  1. 1London

Hospitals in England would need 7000 fewer emergency beds if all hospitals reduced their rate of admission and average length of stay for the over-65s to the same levels as those of the best performing hospitals, shows a report by the healthcare think tank the King’s Fund.1

The report says that 2.3 million fewer bed days would be needed each year if all hospitals performed as well as those in the top quarter of primary care trust areas. Freeing up these beds would save £462m (€590m; $720m) a year, which could be reinvested in community and primary care services.

Every year there are two million unplanned admissions of patients aged over 65, and these admissions are responsible for over two thirds of all hospital emergency bed days.

But the report shows a fourfold difference between the lowest and highest performing primary care trusts in their use of hospital emergency beds for the over-65s. It also shows that areas with lower emergency bed use for older people delivered a good patient experience and had lower readmission rates.

The authors looked at the factors behind this variation in emergency bed use and found that they were complex. It was not as simple as whether a hospital was based in an area with easy access of patients to services such as GPs, community nursing, and social care.

Primary care trusts with the highest emergency bed use tended to have long lengths of stay among patients in transition between home and supported care, suggesting poorer integration of community, primary, and acute provider services. The average stay in trusts with the highest emergency bed use was 36 days, whereas stays were at least nine days shorter in the trusts with the lowest.

Areas with a higher proportion of elderly people had lower rates of emergency bed use, indicating that these areas may have prioritised the needs of older people and had better strategies in place to minimise admissions. Rural areas had much lower use of emergency beds than urban ones. Seven of the 10 trusts with the highest emergency bed use were in London.

The report’s authors identified several factors that seemed to contribute to lower use of emergency beds. The presence of a senior physician at the admission stage was found to reduce general admissions by 12% and admissions to acute medical units by 21%. Meanwhile, frequent medical review, specialist input and training in geriatrics, stroke, and dementia, and access to therapist assessment were found to reduce length of stay.

The report says that local areas need to develop local strategies to “look across the system and align ways of working between primary, community, and acute care to reduce avoidable admissions and length of stay in hospital.” In particular, the new clinical commissioning groups need to pay careful attention to their relationship with providers, as a closer working relationship allows more integrated models of care and reduced admissions.

Candace Imison, deputy director of policy at the King’s Fund and the report’s lead author, said, “With better design and coordination of services focused on the needs of older people, we estimate that the NHS could reduce overnight hospital stays by 2.3 million annually. Not only would this minimise exposure to psychological and clinical risk [for elderly patients] but it would provide a model of care that is far more clinically and financially sustainable.”


Cite this as: BMJ 2012;345:e5434


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