How can frontline expertise and new models of care best contribute to safely reducing avoidable acute admissions?

The study aims to investigate how clinician expertise and decision-making pathways in four contrasting hospitals contribute to admission avoidance in acute care, and to make recommendations about Admission Avoidance models and their impact on workload management at the hospital front end.

The design comprises a case-study design of four acute admission sites, using primarily qualitative and additional quantitative methods, in two periods of data collection, with a mid-project stakeholders conference and learning sets between these phases. The study incorporates:

• Ethnographic qualitative methods (observation, interview and documentation analysis)

• Up to 6 mini case studies of patient journeys in each of the four case sites

• Quantitative analysis of key processes of care.

• An embedded study of cost.

• A parallel learning set to encourage exchange of ideas and learning across sites

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