Can Significant Event Audit identify key factors that might help avoidable hospital admissions?

Nonelective hospital admissions are unplanned admissions. These are stressful for patients, expensive, and it is thought that a large number could be avoided. There is little evidence for effective interventions to reduce unplanned admissions, which have increased by 2.4% each year over the past 11 years.

Significant Event Audit (SEA) is a type of detailed review of individual case notes of patients by their practice team. It is already used widely in general practice, but it has not yet been routinely used for looking at unplanned admissions. We will perform a study in 20 general practices to test whether SEA is acceptable for analysing unplanned admissions for avoidable factors, to improve this approach if indicated, and to gather data needed to run a larger study. We shall provide training for one clinician and one nonclinician from each practice to enable the practice to carry out SEAs in a standard way. First the hospitals will identify a sample of patients with an unplanned admission.

Practices will approach these patients for consent, and look at (1) details of what happened before the admission (2) the people and systems that were involved (3) what might have been done differently to avoid the admission and (4) develop specific action points to promote change in practice that might help reduce future unplanned admissions. These factors will be summarised as part of the report for this study, to help design a larger scale study which will determine whether SEA of unplanned admissions in primary care will lead to a subsequent reduction in nonelective admissions. This information may lead to a reduction in unplanned admissions in the future.

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