The recent report by the National Audit Office (NAO) shows that there were 5.8 million emergency admissions in the year 2016-17. It also analyses activity in the period between 2013-17, taking a system-wide view to include acute, primary, community and social care, and assesses progress made in reducing admissions. It makes for interesting reading and, as well as some key statistics, it offers interesting observations about the efficient and effective treatment of patients.
Firstly, let’s look at some of the statistics from the NAO report on emergency admissions. The 5.8m figure is up by 2.1% from 2015-16 and, overall, emergency admissions grew by 9.3% from 2013-17. Nearly half of last year’s admissions resulted in patients staying for two or more nights and the number of bed days used by those admitted increased by 3.6% between 2013-17.
Older people made up more than half of the growth in emergency admissions between 2013-17 and emergency admissions for people aged 65 and over grew by 12%, almost twice the rate of population growth. This isn’t likely to slow down either as the number of people in this age bracket is projected to increase by a further 20% between 2017 and 2027.
As well as presenting the statistics for demand and the performance of A&Es to meet it, the report goes on to assess how the situation can be improved. It hones in on the vital (and currently missing) pieces of the puzzle: better data, interoperability and digital solutions at the point of care.
Data is crucial to supporting change
While the top-line picture of increasing numbers of emergency admissions is clear, robust evidence for what works to reduce this is missing. NHS Digital and the Royal College of Emergency Medicine have noted a significant lack of data. For instance, only half of patients had a diagnosis recorded, and the reporting was often poor. A&E is, of course, a very challenging environment so finding ways to make it easier to capture (and act on) data is essential.
Better data means clarity and consistency of classification. At ExtraMed, we’ve implemented the ECDS (Emergency Care Data Set) classifications in our solutions. The simplified classification helps frontline staff quickly understand patient needs, as well as giving providers better data for service planning and trend analysis. For example, they can more easily identify opportunities to signpost patients to more appropriate services such as walk-in centres or minor injury units.
Better tracking across the wider care system
NHS England can’t assess the impact of out of hospital care on emergency admissions due to a lack of linked data across health and social care. Neither can it assess the impact of out-of-hospital care on rates of emergency admissions as there’s no national data collection on community care (which is compounded by an inability to link hospital activity data with primary and social care data). The gaps mean it’s hard to track the patient journey at scale and so identify the impact of differing health and social care interventions.
We’ve seen first-hand how the ability to share information within the wider healthcare system delivers significant benefits and improves the patient experience. It also allows health and social care practitioners make more informed decisions about whether a patient requires emergency hospital treatment.
Where initiatives have been launched to integrate with the wider healthcare economy – like at Derby Hospitals NHS Trust – there is a clearer view and better coordination and efficiency on both the admission and discharge side of the system.
From a strategic standpoint, this level of information enables researchers and policy-makers to understand which interventions are effective in reducing demand for emergency admissions as more effective discharge processes lead to lower readmission rates.
Interoperability inside and outside the hospital
Trusts must share parts of their data sets with other systems and teams – EDD (Expected Discharge Date) and NEWS score are prime examples. Digital technology at the point of care makes it easier for everyone involved to prioritise, manage and deliver that care – without having to phone around, dig out notes, look for notes, take notes on paper, or decipher handwriting. This contributes to what we call ‘patient-status-at-a-glance’. It saves time, increases visibility, improves accuracy and supports better care.
The use of digital technology also adds a level of ‘proactive alerting’. A good example is that, instead of ringing round ward after ward to find a bed, A&E staff can see the availability themselves, in real time, and request the bed via the system, initiating the next actions on the care pathway.
Digital transformation at the point of care
One of the key take-aways from the report is the need for data and solutions to support care delivery and decision-making in real-time, and insight and learning over time. If the Trusts are to evolve their processes they need to put usable, flexible, powerful digital technology at the point of care.
We’ve seen it provide great support to initiatives like Red2Green and Clinical Utilisation Reviews, helping to get the right patients in the right places and make the best use of the resources. Digital technology lets us capture data about the hospital’s activities that should be the basis for process improvements, service planning and, ultimately, performance improvement. Which is exactly what the NAO report recommends.