Avoiding unnecessary use of emergency hospital services is one of the biggest challenges facing the NHS. Emergency hospital admissions represent around two-thirds of all hospital bed days in England, with 34 million bed days and over 5 million emergency admissions recorded in 2012/13. In 2012/2013, Bristol reported the highest rate of emergency bed days for long-term conditions in the South West Strategic Health Authority (SHA), with a rate 10.7 per cent higher than the national average. During the same period, the total cost of unscheduled hospital admissions was 17 per cent higher than the SHA average.
The Avoiding Hospital Admissions Health Integration Team (ITHAcA HIT) aims to reduce avoidable hospital admissions across Bristol, North Somerset and South Gloucestershire. ITHAcA is a partnership between the NHS acute trusts, two universities, Clinical Commissioning Groups (Bristol, North Somerset and South Gloucestershire) and the Avon and Wiltshire Mental Health Partnership (AWP). Collaboration across these organisations is vital if a successful reduction of avoidable admissions is to be achieved, and ITHAcA provides a vehicle through which such discussions and partnerships can occur.
ITHAcA HIT aims to reduce the complexity in the local urgent care system and to develop the capacity to use data in evaluating changes and optimising the productivity of existing and new interventions. ITHAcA has four priority themes:
The team's programme of work has begun with a focus on COPD, with a successful bid to the NIHR Health Services & Delivery Research (HS&DR) programme to evaluate admission and discharge care bundles for people with COPD, in collaboration with the British Thoracic Society. They have also recently completed a local study exploring provision and use of services for adults with COPD in the Bristol area and have secured additional funding to extend this work into the area of childhood asthma. Applications for future research include an NIHR Programme Development Grant to inform the management of uncertainty around admission decisions for older people.
They are also focusing on the development of the HIT as an information repository, through the creation of a website offering information about avoidable admissions. ITHAcA has begun to host a series of Discussion Working Groups (DWGs), which are designed to provide 'co-ordination capability' to mobilise evidence between researchers and commissioners. Two of these groups have been held; one on virtual wards and another on Unplanned Admissions Direct Enhanced Service (DES). This initiative is being evaluated by Warwick Business School as part of their project to examine the critical review capacity of CCG led commissioning networks, with respect to interventions to reduce unnecessary hospital admissions for the elderly.
Ideas for future research projects are being circulated and discussed. Potential ideas for collaboration include the evaluation of voluntary sector services as a way to avoid unnecessary in-patient care admissions and the evaluation of an existing hospital discharge service aimed at reducing future re-admissions.