Reducing unplanned hospital admissions in patients with neuromuscular diseases: an NHS re-audit

Abstract

Background: Patients with neuromuscular diseases (NMDs) require long-term multidisciplinary care. Access to specialised NMD services is still variable across the UK. In 2012, an audit showed a high frequency of emergency admissions in this patient population, which were more likely to happen if care was poorly coordinated and not proactive in preventing NMDs complications. The audit was followed by several recommendations and a partnership approach project. Aims: To assess the impact of the previous Audit Methods: A re-audit was undertaken across the same specialised commissioning groups in Central and SouthEast England. Results: More patients were known to specialised centres in NMDs, and the majority of admissions were under the care of Neurosciences (77%) as compared to 2012 when only 14.9% were admitted under Neuroscience. Improvements included a reduction in preventable admissions directly related to known NMDs (from 63% to 32.8%) and reduction in re-admissions (from 25.1% to 12.4%). The mortality rate dropped from 4.5% to 0.3%. Patients known to a NMD specialised service had shorter hospital stay and fewer ITU admissions than patients who were not known to specialised services. Conclusion: The re-audit on unplanned hospital admissions in England highlighted the importance of coordination of care at specialised services for patients with neuromuscular disorders. It successfully documented improvements in the care provided to patients with NMDs in the assessed regions.

Improving specialised care for neuromuscular patients reduces the frequency of preventable emergency hospital admissions

“…These two retrospective case note review audits (A1 and A2) conducted over a five-year interval aimed to identify the number and reasons for preventable emergency admissions in people with NMD, the full reports of these audits can be accessed on line [17,18]. It was anticipated that by reducing emergency admissions for this population, significant cost savings could be made and the quality of life for NMD patients improved.…”

“…Admissions scored as 'preventable' accounted for 216/576 (37%) of all admissions in A1 and 79/361 (22%) in A2. The proportion of preventable admissions for patients with a previous known diagnosis of NMD was shown to have reduced by almost 50% from 143/127 (63%) in A1 to 63/192 (33%) in A2 [18]. In A1 there were 63 admissions to intensive care, 32% of these admissions were considered preventable and only 28% of patients were known to a neuromuscular service.…”

“…A1 assessed case-notes for emergency admissions directly related to an underlying NMD during the period: 1st January 2009 until 30th June 2011 [17]. A2 assessed case-notes for emergency admissions from 1st January 2014-until 30th June 2016 [18]. Where there were: incomplete medical notes, elective admissions, incorrect coding i.e.…”