KISS: Unplanned Admissions in Scotland, Wales and Northern Ireland

Reducing unplanned admissions is very much on the agenda throughout the UK, and not just in England where there is a major new contractual requirement to identify those at high risk and optimise their care. This is the current situation elsewhere in the UK. Do let us know if there are other initiatives in your area.  

Scotland

Scotland is leading the way on the reducing unplanned admissions agenda, in terms of both primary research and implementation.

The key primary research came from Nairn showing that risk identification and use of anticipatory care plans ACP Study reduced unplanned admissions and hospital bed days. A key part of the success is a rapidly responsive, multi-disciplinary case management team and integration between health and social care. Health and Social Care partnerships and integrated community support teams have been established, and are a key part of an ambitious programme of reform in Scotland

Instead of the English Enhanced Service, in Scotland there are significant changes in the Quality and safety domain of the  Scottish QOF  which focus on reducing unplanned admissions:

•   Reviews on emergency admissions, including external peer review
• GP practices to identify a liaison GP for health and social care integration within the new Health and Social care partnership
• GPs to produce a list of 5% of patients in the practice identified as high risk of admission, using a risk stratification tool (such as SPARRA or equivalent
• Anticipatory care plans should be completed for 30% of these patients
• The ACP should include a polypharmacy review and be shared with OOH care
• There should be quarterly meetings to discuss these patients with ACPs

There is already evidence accruing (awaiting publication, Dr Conrad Harvey personal communication) that implementation of this programme has lead to a 50% reduction in unplanned admissions and a 36% reduction in bed days.

Northern Ireland

In NI this is apart of the Quality & Productivity (QP) scheme to

·      Review emergency admissions and A&E attendances

·      There is work going on at present looking at risk stratification. This is at an early stage at present, but is highly likely to come in shortly

Wales

In Wales ‘complex’ cases have had to be reviewed, as part of QOF, with the aim of reducing unplanned admissions with quarterly meetings. As far as we know, there is no plan at this stage to introduce risk stratification and case management.