David Oliver: Avoiding hospital admission—are we really falling short?
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l747 (Published 26 February 2019) Cite this as: BMJ 2019;364:l747
- David Oliver, consultant in geriatrics and acute general medicine
- Berkshire
- davidoliver372{at}googlemail.com
Follow David on Twitter: @mancunianmedic
Last week I wrote about the huge policy push to keep patients away from acute hospitals. The focus isn’t surprising, with full hospitals, rising attendance and admission rates, “exit block” in patients who could technically leave,1 potential distress or risks to patients resulting from admission,23 and patients whose problems might have been prevented or dealt with upstream of hospital and closer to home.45
Here, I want to look at whether the evidence supports such efforts and how we might reframe the issue rather than reflexively labelling acute hospital activity as a problem.
No consistent evidence
The empirical evidence is problematic. Many small scale pockets of innovation have modestly cut hospital attendance or admissions. This has been shown in recent reports on primary care home projects6 or NHS England’s “enhanced health in care homes” vanguards,7 as well as …