Simple follow-up 'aftercare' could reduce hospital readmissions in geriatric patients

Costly hospital readmissions in geriatric patients could be nearly halved if the NHS offered simple follow-up 'aftercare' calls and home visits for patients, according to a new study.

The research, by Aston University's School of Life and Health Sciences, suggests that readmissions could be slashed by as much as 41% if health authorities routinely made post-discharge calls to elderly patients after they are released from hospital.

The checks could amount to nothing more than a brief phone call from a community nurse, offering straightforward advice on medication management to older patients, through to referrals to community health providers including GPs and pharmacists.

The findings have been published in the Royal College of Physicians' Future Healthcare Journal.

Dr James Brown, Senior Lecturer in Life and Health Sciences at Aston University and one of the experts involved in hit Channel 4 TV series 'Old People's Home for 4 Year Olds', said:

Our work shows that a simple service, whereby community nurses attempt to contact older adult patients after they are discharged from hospital, lead to a significant reduction in the number of patients readmitted within a month.

The combination of Britain's ageing population and an under-pressure NHS means it is now more important than ever to minimize the costs to our health services caused by unnecessary readmissions.

It may seem hard to believe that something as simple as a phone call can have such a major impact, but our evidence suggests that this is so - the NHS could tackle the rise in readmissions by implementing simple, inexpensive telephone services which improve communication with patients."

According to NHS figures published in March this year, there were 865,625 emergency readmissions to hospital within 30 days of discharge in England in 2017-18. The problem is particularly acute amongst elderly patients, and approximately 15 per cent of over-65s are readmitted within 28 days.

According to the independent Healthwatch watchdog, over the five years between 2013/14 and 2017-18 emergency readmissions increased by 21.8% based on its analysis of the situation in 70 English hospital trusts. Healthwatch has estimated the total cost of emergency readmissions at around £2.4bn per year.

Dr Brown's research looked at two groups of elderly patients in Solihull, West Midlands - 303 who community nurses attempted to contact to offer a home visit after discharge, and a comparison group of 453 others. Of the 303 patients in the intervention group, there was successful telephone contact with 288, and 202 received a home visit.

Almost 16 per cent of the comparison group were readmitted as emergencies within 30 days of leaving hospital. But among those who community nurses contacted and visited, that figure was only 9 per cent. This means that patients where there was no attempt to contact were almost twice as likely to be readmitted to hospital within 30 days of being discharged.

Dr Brown added:

While NICE guidance recommends that a discharge coordinator should follow-up with people leaving hospital within 24 hours, the rising rates of readmissions, especially for older people, suggest this isn't happening as a matter of course.

"This new evidence suggests NHS trusts and community teams could substantially reduce the pressure on their services from simple interventions, potentially freeing up thousands of beds and cutting the huge costs associated with unplanned hospital stays."

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