Hospital Admissions Policy
Reducing emergency hospital attendances, for patients, carers and health providers, by improving out-of-hospital care.
Calls to emergency health services have increased from 4.9million in 2002/2003 to 9.1million in England in 2012/2013[1]. Traditionally, ambulances responded to all calls, with default transportation to emergency departments, but health systems are unable to cope with the increased demand and associated costs (emergency admissions cost NHS England £13 billion a year – source: Audit Commission). Over the last 15 years Professor Snooks team at Swansea University have undertaken a major research programme to identify safe and cost-effective alternatives to ambulance dispatch and onward transport to hospital. Snooks and colleagues’ approach is founded upon collaboration and engagement - with policy makers, the NHS and patients as full partners, helping to prioritise and shape all aspects of the research. The team formed the UK wide 999 Emergency Services Research (EMS) Forum and TRUST research groups – both of which build capacity across trauma and unscheduled care research, help set research priorities and promote evidence based care. The team’s reputation for leadership in emergency care is enhanced through publications, the annual 999 EMS conference featuring international speakers, and public appearances such as recent BBC and RTE (Ireland) television news features.
Supported by over £4million in government grants, the team’s research features 22 studies exploring emergency care practice and safe and cost-effective alternatives. They include:
- An international review revealing that most emergency calls were neither life-threatening nor serious, and 40% did not require an ambulance.
- A study of older people who had fallen showing that a high proportion made emergency care contacts within two weeks, and identifying a five-fold increase in risk of admission or death.
- Trials featuring paramedics with extended training proving that they could provide a clinically effective alternative to ambulance transfer and treatment in ED for elderly patients with acute minor conditions.
- A further trial showing that paramedics using a computerised decision support tool for the care of older fallers was safe and increased community falls service referrals.
- Studies showing that telephone assessment and advice for patients with non-serious problems, reduced emergency ambulance dispatch rates without increasing risk.
- A further study confirming the safety and effectiveness of NHS Direct nurses providing advice to emergency ambulance service callers.
The research has provided a scientific, evidence-based foundation for a major shift in hospital transport by ambulance, with widespread international adoption in policy and operational plans of ambulance service providers. Enhanced telephone triage, treat and refer, and extended paramedic roles have been adopted by all UK ambulance service providers, and many abroad where similar challenges apply. The impact on emergency care is profound. In England for example, emergency calls not leading to hospital transport rose from 480,000 in 2001 (10%) to 4.1 million in 2013 (45%) with savings from avoided ambulance journeys of £60million (source: Health and Social Care Information Centre). Moreover, the result is improved availability of ambulance services for those at most need, reducing avoidable illness and deaths, and reductions in the costs, stress and disruption to patients and families of unnecessary hospital admissions.
Professor Snooks’ evaluative work was used in the strategic review of NHS Ambulance Services in England, the catalyst for transforming ambulance services over the last seven years. Snooks’ work has helped us to modernise ambulance services, professionalise ambulance service staff, and provide care that is more efficient for the NHS and appropriate for patients, whilst maintaining safety standards.
National Ambulance Director (2004-12); Chief Executive, London Ambulance Service (2000-12)