Better use of technology can cut emergency admissions
Hospital staff are bracing themselves for a surge in emergency admissions this winter, but a new report claims the effect of the rise could be mitigated if financial savings are made elsewhere in the NHS
Hospital staff are bracing themselves for a surge in emergency admissions this winter, but a new report claims the effect of the rise could be mitigated if financial savings are made elsewhere in the NHS.
In 2012/13, there were more than 5.4 million emergency admissions in England. This accounts for one third of hospital admissions and two thirds of all bed days. The estimated cost of emergency admissions to the NHS in 2010/11 was more than £11 billion.
However, the Medical Technology Group (MTG), a coalition of charities, patient organisations and medical device manufacturers, claims to have found ways to save £1 billion.
In Admissions of Failure, a report examining unplanned hospital admissions published last month, MTG warns that the NHS is ‘under-utilising’ relatively standard equipment and devices in three areas: urinary tract infections (UTIs), diabetes and heart failure. By targeting these areas. the group claims, the NHS can save money.
MTG’s researchers reached this conclusion after making freedom of information requests for data from 161 NHS trusts and 211 clinical commissioning groups.
MTG chair Barbara Harpham says that, when the NHS is being asked to make savings, technology ‘cannot be ignored’. She adds that tackling unplanned admissions will be vital to achieve the goal set out in NHS England’s Five Year Forward View to save £22 billion by 2020.
‘For the NHS, better managed demand means radical savings,’ she says. ‘There is clear and compelling evidence from the NHS and other developed health economies to show technology can improve our ability to predict, diagnose and treat diseases, and so dramatically reduce unplanned admissions for patients lucky enough to have access to it.’
In discussing how the NHS prevents UTIs linked to the use of catheters and prevents blocked catheters, for example, the report highlights the importance of using pre-connected urinary catheters and drainage bags in units where there are high infection rates.
The MTG calls for better use of bladder ultrasound scanners to assess urinary retention and determine catheter need. It also recommends the use of Foley trays, which contain everything needed for catheterisation. One trust that has started to use Foley trays had seen the number of UTIs linked to catheters fall by 44% in six months.
The report stresses the importance of insulin pumps for people with type 1 diabetes who struggle to control their blood-glucose levels with daily injections. It states that insulin pumps can reduce the numbers of admissions and outpatient appointments with consultants, as well as the risk of complications, such as heart disease, stroke and blindness.
The National Institute for Health and Care Excellence recommends that 12% of type 1 diabetes patients should use insulin pumps, but suggests that only about 6% do. This low uptake compares with that in countries such as Sweden, France and Germany, where between 15% and 20% of patients use them.
For heart failure, the report discusses the merits of implants, such as implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy defibrillators (CRT-Ds). It points to evidence that these devices can perform ‘significantly better’ in preventing admissions and deaths than drug treatment. This evidence includes a review of clinical trials between 2006 and 2013, which found CRT-Ds are associated with a 42% lower death rate lower compared with drug treatment. Similarly, ICDs are associated with a 29% lower death rate. Following their use, hospital admissions were 33% and 20% lower, respectively.
The report warns that the UK is is ranked 20th in Europe in terms of using the implants, although CRT-D use has been increasing in recent years.
The report makes a compelling case, but how realistic are the savings?
A spokesperson for NHS England says that, while some money can be saved, it would be unrealistic to think that an entire £1 billion could be conserved in the way the MTG proposes. Nonetheless, Ms Harpham says technology is an important area of investment. ‘The NHS has a strong track record in developing and using new medical technologies, such as diagnostic ultrasound and magnetic resonance imaging (MRI) scanners, to revolutionise the way we care for and treat patients,’ she says.
‘Last May, we launched the £500 million Safer Wards, Safer Hospitals Technology Fund to help patients get better and safer care by giving doctors access to the right information when they need it most, and better use of technology is a key part of the Five Year Forward View.’
RCN professional lead for acute, emergency and critical care Anna Crossley says that the best technology is only part of the solution, citing that staff training and resources are important too.
‘Additional investment in community and intermediate care, alongside new technology, will reinforce patient self-management of conditions.’
However, she says such services have been ‘slowly eroded’ over recent years: ‘It is becoming increasingly difficult for patients to access community and specialist nursing services. So patients are less educated about their illness and lack support when they worsen.
‘People’s health and social care needs are not being met unless they are admitted, and patients have lost their confidence in self-management. These patients attend emergency departments needing admission, which adds pressure on the hospital system and increases demands on nursing staff.’
The squeeze on resources also affects the other end of the hospital pathway. NHS England figures show that, in September, delayed discharges rose to their highest levels since record-keeping began, in 2010. At the end of the month, more than 5,000 patients were ready for discharge but could not be released.
Discharge delay was a major theme of The Health and Care of Older People in England 2015, a recent report by Age UK. It describes the pressures that delays cause as a ‘destructive vicious circle’.
The report says that council-run care services have been cut in real terms by nearly £2 billion over the past decade, which means that a growing number of people have unmet care needs.
Community nursing posts
Between 2009 and 2014, meanwhile, the number of community nursing posts fell by 8% to around 36,000.
The report links these reductions to an ‘alarming increase’ in illnesses, including UTIs, heart failure and pneumonia, in older people.
The over-65s account for more than two million emergency admissions each year, or nearly half of the total, with numbers rising by 22% among this age group over the past seven years.
Age UK policy adviser Jill Mortimer says: ‘Emergency admissions are bad for patients, particularly older people. When they are admitted to hospital, they spend longer in hospital and their frailty increases.
‘To address this, we need to look at the whole picture across health and care sectors. Only then will we reduce emergency admissions.’
How to save £1 billion
Urinary tract infections
- 184,000 emergency admissions for UTIs at an average cost of £2,361 per case
- 17,641 emergency admissions for blocked catheters at £1,012 per case
- Use pre-connected urinary catheters and drainage bags in high-risk areas
- Use bladder ultrasound scanners to determine catheter need
- Use Foley trays to reduce the risk of infections
- £434 million on UTIs and £18 million on blocked catheters
- 16,000 emergency admissions for ketoacidosis due to a severe lack of insulin at a cost of £4,477 per case
- 29,000 emergency admissions for hypoglycaemia at £2,481 per case
- 22,572 emergency admissions for hyperglycaemia at £1,505 per case
- Insulin pumps can help those struggling to maintain target blood glucose levels.
- £119 million for ketoacidosis, £72 million from hypoglycaemia and £34 million from hyperglycaemia
- Nearly nine in ten admissions to hospital for heart failure are unplanned
- There is a large regional variation in proportion of patients with heart failure who end up in hospital, from 66% in the south west to 16% in the West Midlands
- Combining cardiac resynchronisation therapy and defibrillation.
- £349 million
Total potential saving:
The Age UK report