Nottingham University Business School

Centre for Health Innovation, Leadership and Learning (CHILL)

Reducing Unplanned Admissions to Hospital in the Elderly (Escape 85+)

This study sought to establish and implement best practice to reduce unplanned admissions to hospital for patients aged 85 years and over. In England, between 2007/8 and 2009/10, the rate of unplanned hospital admissions of people aged 85 years and above rose from 48% to 52%. There was substantial variation, with some areas showing a much faster rate of increase and others showing a decline.

Project aims

  • To identify system characteristics associated with higher and lower increases in unplanned hospital admission rates in those aged 85 years and over
  • To develop recommendations to inform providers and commissioners
  • To investigate the challenges of starting to implement these recommendations

How was CHILL involved?

CHILL provided methodological and theoretical guidance in the design, management and delivery of the work, including analysis of system-led processes.

Project highlights

  • Between 2007/8 and 2009/10, average hospital admission rates for people aged 85 years and over rose by 5.5% annually in ‘deteriorating’ sites, and fell by 1% annually in ‘improving’ sites.
  • In deteriorating sites, there were problems with general practitioner access, pressures on emergency departments and a lack of community-based alternatives to admission.
  • The most striking difference between improving and deteriorating sites was not the presence or absence of specific services, but the extent to which integration within and between types of service had been achieved.
  • There were overwhelming differences in leadership, culture and strategic development at the system level.
  • The recommendations emphasise the importance of issues such as maximising integration of services, strategic leadership and adopting a system-wide approach to reconfiguration.

Project team

Principal Investigator: Professor Andrew Wilson, University of Leicester

CHILL team: Professor Justin Waring, University of Nottingham

Funder: NIHR Health Services and Delivery Research (HS&DR) Programme.

Project status: Complete 2014

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Outputs and links

ESCAPE 85+ Abstract (Journals Library)









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