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Rising readmissions indicate problems with older patient care

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Emergency readmissions to hospital have risen by almost a fifth in seven years pointing to problems in the way older patients are cared for, according to new research.

Research by leading think-tanks found that between 2010-11 and 2016-17 there was a 19% rise in emergency readmissions within 30 days of a patient leaving hospital.

“Unnecessary trips and overnight stays in hospital put a strain on elderly patients”

John Appleby

Of that figure, 41% were classified as “potentially preventable” conditions, such as pneumonia, pressure sores and venous thromboembolism (VTE) – conditions that were not diagnosed when the patients were first admitted.

The Nuffield Trust and the Health Foundation said the findings raised serious questions about how older people were cared for in hospital, the discharge process, and the quality of community and social care services.

However, it acknowledged that the increases may be partly down to changes in how conditions are coded in hospital, as well as a rapidly growing older population.

The proportion of all hospital stays that were followed by these types of readmission grew from 0.8% in 2010-11 to 1.1% in 2016-17.

“These findings reflect the impact 40,000 nurse vacancies has on patient care”

Donna Kinnair

The research included a day by day breakdown for the 30 days after a hospital stay and found that the highest proportion of readmissions occurred one day after discharge.

Emergency pneumonia readmissions increased the most – from 41,003 to 70,731 during that period. Emergency readmissions for pressure ulcers almost trebled to 22,448, while the number for VTE grew by a third to 23,006.

Professor John Appleby, the Nuffield Trust’s director of research, said it was “concerning” that the number of emergency readmissions had grown.

“Unnecessary trips and overnight stays in hospital put a strain on elderly patients and their families,” he said.

Jessica Morris, an analyst at the think-tank who authored the report on the research, added: “Emergency readmissions to hospital, for conditions that were not diagnosed during their first visit, are potentially a warning sign that a patient’s quality of care may have been compromised.

“The findings provide local health providers with a good opportunity to sit up and focus their attention and quality improvement initiatives on the three conditions where we’ve seen the most significant rise in readmissions,” she said.

“Too often, bed occupancy is at unsafe levels and medical and nursing staff are working flat out”

Niall Dickson

The research – titled Emergency readmissions: Trends in emergency readmissions to hospital in England – was published by QualityWatch, a joint programme by the Nuffield Trust and the Health Foundation charity to analyse health and social care data.

Donna Kinnair, director of nursing policy and practice at the Royal College of Nursing, said: “These findings reflect the impact 40,000 nurse vacancies has on patient care.

“Nurses want to do the best they can for their patients, but with hospitals struggling to recruit and shifts left unfilled, there are too few nurses to deliver the best care,” she said.

“Patient mortality rises and falls with the number of nurses on duty,” she said. “To improve patient care, the government urgently needs to recruit and retain more nurses, and enshrine safe and effective staffing levels in law.”

Niall Dickson, chief executive of the NHS Confederation, an umbrella group representing organisations across the healthcare sector, said: “This should come as no surprise to anyone – the system is operating at a level that is stretching staff and resources beyond the point where they are most effective.

“Too often, bed occupancy is at unsafe levels and medical and nursing staff are working flat out, with too few of them to deliver optimal care,” he said. “Meanwhile, there are simply not enough resources in the community to prevent admissions and readmissions.

“Without new ways of delivering services and sustained investment, NHS and social care services will not cope,” he warned.

Linda Thomas, vice chair of the Local Government Association’s Community Wellbeing Board, also said the readmission trends identified by the think-tanks were “extremely concerning”.

“Adult social care is essential to reducing pressures on the NHS – since July 2017, transfer of care delays due to social care have fallen by about 30% – and needs to be put on an equal footing to the health service if delayed transfers of care are to be reduced further,” she said. 

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