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Professional perspectives on systemic barriers to admission avoidance:learning from a system dynamics study of older people’s admission pathways

Professional perspectives on systemic barriers to admission avoidance:learning from a system dynamics study of older people’s admission pathways
Professional perspectives on systemic barriers to admission avoidance:learning from a system dynamics study of older people’s admission pathways
Background
There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions.

Objectives
To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions.

Design
A qualitative framework analysis of interview data from a System dynamics (SD) modelling study.

Methods
Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis.

Results
Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign.

Conclusions
Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system.

Implications for practice
Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs.
1748-3735
1-10
Walsh, B.
5818243e-048d-4b4b-88c5-231b0e419427
Lattimer, V.
5aa2c9a5-13cb-4776-9b0d-c618e6913f5b
Wintrup, Julie
9f1df4c7-aae8-4d0e-9176-8e33b7417370
Brailsford, S.C.
634585ff-c828-46ca-b33d-7ac017dda04f
Walsh, B.
5818243e-048d-4b4b-88c5-231b0e419427
Lattimer, V.
5aa2c9a5-13cb-4776-9b0d-c618e6913f5b
Wintrup, Julie
9f1df4c7-aae8-4d0e-9176-8e33b7417370
Brailsford, S.C.
634585ff-c828-46ca-b33d-7ac017dda04f

Walsh, B., Lattimer, V., Wintrup, Julie and Brailsford, S.C. (2014) Professional perspectives on systemic barriers to admission avoidance:learning from a system dynamics study of older people’s admission pathways. International Journal of Older People Nursing, 1-10. (doi:10.1111/opn.12056).

Record type: Article

Abstract

Background
There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions.

Objectives
To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions.

Design
A qualitative framework analysis of interview data from a System dynamics (SD) modelling study.

Methods
Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis.

Results
Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign.

Conclusions
Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system.

Implications for practice
Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs.

Text
IJOPN professional interviews.pdf - Other
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More information

Published date: 21 May 2014
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 365904
URI: http://eprints.soton.ac.uk/id/eprint/365904
ISSN: 1748-3735
PURE UUID: 248aacbe-a9de-42f4-9719-492028148a80
ORCID for B. Walsh: ORCID iD orcid.org/0000-0003-1008-0545
ORCID for S.C. Brailsford: ORCID iD orcid.org/0000-0002-6665-8230

Catalogue record

Date deposited: 23 Jun 2014 09:43
Last modified: 15 Mar 2024 02:59

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Contributors

Author: B. Walsh ORCID iD
Author: V. Lattimer
Author: Julie Wintrup
Author: S.C. Brailsford ORCID iD

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