In and Out of Hospital – tackling hospital readmissions

February 2, 2018

A new report by British Red Cross looking at tackling hospital readmissions says that repeat visits to A&E should trigger automatic home checks.

In and Out of Hospital, published by the British Red Cross, warns of an ‘endless cycle of avoidable hospital readmissions’, in which some frail, older or vulnerable people are sent home from hospital without the right care in place, only to go straight back to emergency departments.

The charity says that many of the older or vulnerable people it supports don’t feel safe in their own homes and fears they may be returning from hospital to unsuitable conditions.

Latest figures from Healthwatch show that emergency hospital readmissions have risen by 22.8% in the last five years, with the number of people being readmitted within 48 hours now accounting for one in five of all emergency readmissions.

This new report, based on the first-hand accounts of frontline health and care workers, British Red Cross staff and volunteers, as well as vulnerable people supported by the charity, recommends automatic home checks to prevent a person’s condition deteriorating further and help put a stop to repeated visits to hospital.

The charity argues that while a patient might appear to be medically fit enough for discharge, repeated visits to hospital signal that something might be amiss in their home environment.

The British Red Cross highlights that there is no agreed, consistent approach to flagging repeat admissions and attendances. Often it takes a person falling into crisis before any kind of support package is put in place, by which time their needs have spiralled and become increasingly complex.

The charity argues that a series of simple interventions between hospital and home, including home checks, could prevent this cycle of re-admissions and discharge much earlier.

The British Red Cross supports around 300,000 people every year with support-at-home services, transport for patients to and from hospital, ambulance support and mobility aid loans. It has run a series of successful pilots aimed at better supporting frequent attenders to hospital, in order to reduce preventable readmissions.

In and Out of Hospital revealed that many frail, older and vulnerable people do not feel safe in their own homes because of the fear of falling. The top six everyday basic tasks that people struggled with were:

  • Taking a shower.
  • Getting dressed.
  • Walking 100 yards.
  • Climbing a flight of stairs.
  • Shopping for food.
  • Doing odd jobs in the house or garden.

It also found a troubling difference between the number of those that live alone accessing both formal and informal support, compared to those that live with others. Those living alone seem less likely to have accessed support to cope with everyday tasks and activities. With more older people living alone, support at home is vital to prevent this cycle of hospital admission.

In and Out of Hospital identifies too many missed opportunities to help prevent people from falling into crisis. It recommends simple interventions that could be adopted at each stage of a patient’s journey, ensuring they are sent home from hospital appropriately with full support and prevented from readmission.

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