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Research project: Improving patient pathways for older people admitted to hospital with 'ill-defined conditions' - Dormant - Dormant

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Reduction of preventable emergency admissions amongst older people is a key priority for the NHS. The potential role of nurses in achieving this is already recognised, although the optimal type and timing of interventions remains open to debate. One priority is to reduce the number of patients admitted to hospital with so-called 'ill- defined conditions', ie signs, symptoms, abnormal laboratory findings and other problems coded in Chapter XVIII of the International Classification of Diseases.

Overview

These admissions appear to be rising, especially in older age groups. These patients may not have acute medical needs, but nursing intervention could improve patient experience and reduce their impact on acute services. However, development of services to achieve these aims requires improved understanding of the ways in which these patients interface with health services and factors underlying such admissions. This work will use a System Dynamics approach (5) to explore these issues and identify potential areas for nursing intervention.

Main question(s)

Research questions are:

  1. What is the incidence of admissions for 'ill-defined conditions' amongst older people compared with the rest of the population?;
  2. What is the impact of such admissions on the local acute care system? 
  3. What are the features of the patient journey through the health care system?;
  4. What are the distinguishing characteristics of these admissions?;
  5. What nursing interventions could be employed and what is the optimal timing for intervention?


Methodology

 
Project 1: Descriptive and correlational analysis of the incidence of admissions for 'ill-defined conditions' using Hospital Episode Statistics (HES)and Patient Administration System (PAS) databases.

Project 2: Qualitative interviews with key professional stakeholders and prospective study of a cohort of older people admitted to medicine/care of the elderly.

Project 3: Computer modelling of admissions for 'ill-defined conditions' and potential points of nursing intervention.

Main outcomes

Project 1 will generate national data on incidence and features of admissions for 'ill-defined conditions'.

Project 2 will result in detailed conceptual maps of the patient journey in 3 acute trusts. It is anticipated that this exercise will benefit service development.

Project 3 will result in a detailed computer model of the patient journey across one health economy. The computer model can then be used to quantify the impact of 'ill-defined' admissions on the acute care system and to explore the system impact of different service scenarios in the future.
Project team

Team Members 

Bronagh Walsh

Project funder

Department of Health National Co-ordinating Centre for Research Capacity Development

Related research groups

Health Work and Systems

Key Publications

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