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NIHR Signal Closing five emergency departments not linked with increased hospital admissions, though ambulance call-outs increased
Closure of five small emergency departments in England was not associated with change in the number of hospital admissions, urgent care attendances or deaths among the local populations. However, ambulance call-outs increased by 14% relative to comparison areas, with a four-minute increase in the time to reach a hospital with an emergency department. Emergency departments continue to be under high pressure, while staff shortages increase patient safety concerns. One option is to close smaller s...
NIHR Signal The proportion of patients not transported to emergency departments after an ambulance is called varies across the country
Nationally, around half of people making urgent calls for ambulance services are not then taken to hospital. This is called the non-conveyancing rate. But this rate varies two-fold from region to region. There are differences too in what happens to patients not going to hospital. Some places discharge more patients at the scene, offer telephone advice or send to other non-emergency health services like walk-in centres. This NIHR mixed methods study used observation and analysis of routine ambul...
NIHR Signal Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs
An electronic referral system including consultant-led triage and an advanced oral surgery service in primary care results in fewer people requiring oral surgery in hospital. It comes at a lower overall cost than the previous arrangement. About two-thirds of patients could be treated safely in enhanced primary settings rather than hospital. This NIHR-funded study implemented several changes, an electronic referral system which standardised and improved the level of information provided in refer...
NIHR Signal Self-care support for children with long-term conditions may reduce emergency costs
Helping children and parents to manage long-term conditions like asthma may reduce their need for emergency care, and is unlikely to reduce children’s quality of life. This NIHR review found that structured professional help with self-care, including online support, provision of care plans, case management and face-to-face education, was linked to small increases in quality of life scores and fewer emergency department visits. However, there was no clear evidence that supported self-care ...
NIHR Signal Introducing a primary care risk prediction tool did not reduce emergency admissions
Predicting emergency admissions paradoxically increased hospital admissions from primary care across all risk groups by about 3% overall. The Predictive Risk Stratification Model (PRISM) was evaluated in a trial in general practices in Wales, and there is little evidence it benefits patients by reducing deaths or improving quality of life either. The number of people living to older age with chronic health conditions is growing. Various risk stratification tools have been introduced across the...
NIHR Signal Study raises questions about NHS “weekend effect”
The increased mortality observed if patients are taken to hospitals at weekends also affects night admissions and can be explained in part by the severity of illness. Five linked NIHR-funded studies reviewed mortality and time and day of admission to hospital, largely using routine England-wide data. Fewer people are admitted from A&E at the weekend. Admission is more likely if they have arrived by ambulance or been referred directly for admission from community services. Though death rate...
NIHR Signal What works to support residents’ health in care homes and why
Long-term relationships and joint working between community health practitioners and care homes are the keys to improving appropriate hospital admissions and access to medications. Additional payments for GPs, jointly agreed protocols, clear role specifications and structured systems have impact only if they trigger and sustain collaborative working. This realist evaluation in 12 English care homes for older people explored contexts for ‘relational working’ in three service delivery...
NIHR Signal Wider stakeholder involvement could overcome resistance to modernising healthcare services
Among principles that can help when decommissioning out-dated, unsafe or poor value services are clear leadership and transparency about the reason for change with patients, clinicians and local communities. Modernising healthcare often involves reducing, replacing and removing services. This is called decommissioning and the task varies with the local context. This NIHR-funded study reviewed previous research and conducted interviews and surveys. Case studies showed consistent problems across...
NIHR Signal Financial incentives do not increase attendance for diabetic eye screening
Two types of financial incentives are not effective at increasing attendance at eye screening for people with diabetes who do not regularly attend screening. Surprisingly, financial incentives may even reduce the numbers of people attending screening. Retinopathy is a type of eye disease common to people with diabetes. Sight deteriorates only in the later stages and early diagnosis and treatment can prevent blindness. Annual eye screening is offered for people with diabetes but take-up could be...
NIHR Signal Specialist hip fracture services linked to fewer deaths in South Central region
Following a hip fracture, nurse-led fracture liaison services or specialist consultant (orthogeriatrician) input both reduce deaths. They did not reduce the small number of people having a second hip fracture within two years of the first. Both models of care were cost effective, although the orthogeriatric model was favoured. Despite national guidance recommending both use of a fracture liaison service and orthogeriatric model of care, variation exists and some hospitals have neither. This NI...
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