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Despite the new ‘needs driven’ criteria for public funded admission to nursing homes, there remains concern that older people are entering such care inappropriately. However, neither previous research or policy makers have sub‐divided such inappropriate entries into their constituent groups: those who are inappropriate because they are too independent and those who are inappropriate because they are too dependent. The aims of this study were to determine the extent of inappropriate nursing home admission amongst older people in nursing homes in six areas of England and Wales between 1995‐96. This was done through a retrospective case‐note review using a structured data‐collection pro forma. Although the study found no evidence of extensive inappropriate placement, extrapolation of these data suggests that 6,750 of those admitted to nursing care could have coped in a more independent environment. The inappropriately admitted group were more likely to have lived alone, be female, elderly and not to have seen a geriatrician. It is concluded that the most effective way to prevent such admissions would be to ensure the involvement of specialist geriatricians in the multidisciplinary team involved in admission decisions.

Aims to assess the impact of a day‐care center (DCC) on hospital bed usage by HIV‐infected patients. Reviews the medical records of 710 hospital admissions of HIV‐infected patients admitted to two Spanish hospitals, one of them with a DCC, over a three‐year period. The proportion of unnecessary admissions was significantly higher in the hospital without a DCC. The rate of hospital admissions among patients who were admitted to hospital was also greater in the hospital without a DCC, as well as the rate of admissions among patients on antiretroviral drugs. Concludes that the availability of a DCC improves the appropriateness of hospital admissions and decreases the number of hospitalizations in HIV‐infected patients.

Although the UK’s health and social care system has always been geared towards dealing with crises, evidence suggests that this is becoming increasingly the case. Changes in health care and the prioritisation of scarce resources have resulted in a situation where those with low level needs are often left unsupported until they experience a major life crisis. To rectify this situation, the government has introduced a range of policies designed to emphasise the need for preventive work. Against this background, this paper focuses on the issue of emergency hospital admissions, critiquing the research methodologies that have been used to investigate the scope for preventive work in this area. Despite the use of more sophisticated and objective research tools, there is a need to develop new ways of researching emergency admissions which build on the strengths of existing approaches while at the same time incorporating more of a user perspective.

The purpose of this paper is to investigate the extent, range and nature of literature concerning the mental health inpatient care of the young adult population (16-25 years) who have been admitted to adult mental health wards. This paper reports the findings and positions these in the context of the broader nature to adult inpatient care, evaluates the quality of the evidence and identify gaps in the literature.

This paper uses an adapted scoping review methodology, allowing for a broad search but utilised established steps that allowed for a structured, rigorous approach to be used. CINAHL, Cochrane Library, MEDLINE, PsycINFO, Google Scholar, plus a secondary hand search were conducted resulting in eight papers, of quantitative, qualitative and mixed methods papers.

Findings show admissions follow similar paths as to adults; admission reasons are largely unknown beyond simple descriptors; admission lengths are unknown whilst on adult wards; staff feel confident yet lack resources; young people feel the transition from CAMHS ward to adult ward can be beneficial if done sensitively; young people have positive experiences of adult wards, including factors that may not be present on CAMHS wards, e.g. role modelling by older patients; young people feel scared and vulnerable, including when excluded from decision making; however, involving young people can cause stress and be confusing if not done sensitively.

The scoping review identified a limited amount of research evidence for the care of young people admitted to adult wards. The research methods used in these papers were varied and none was of a high-quality standard. All studies contained methodological gaps which detract significantly from their findings and conclusions. The studies go some way to fill the gaps in knowledge and evidence base for this group, although in doing this scoping review was to unearth more gaps in knowledge.

This scoping review collates findings from the literature regarding young people’s admissions to adult mental health wards. This sensitive and controversial area of mental health care is shown to be lacking in high-quality research. Young people are being admitted to adult wards in increasing numbers year on year in the UK, yet little research has been conducted to identify when and where treatment has been appropriate. This review provides a start to understanding what is known about admission and treatment for this group and what is not known so that these gaps may be investigated in future research.

This paper seeks to show that there is inappropriate utilization of resources in hospitals in all three health care sectors (whether Ministry of Health, military or private). Such misuses can be tracked down by understanding the factors associated with such utilization.

The results were based on the assessment of some of the health staff and it could be argued that the rate of inappropriate utilization of hospital resources would have been different if it had been based on the patients' own assessments.

The results of this study show that regardless of the hospital type (or ownership), a substantial percentage of respondents perceive that hospital resources are inappropriately utilized. In fact, more than half of respondents in the three health care sectors indicate that the utilization of hospital resources is inappropriate. These results are inline with previous research which reported that the patient or the patient's family can contribute to unnecessary utilization by pressuring the physician to admit or by delaying discharge. In addition, although not examined in this study, patient characteristics such as lack of family support, age and lack of a health post‐discharge influence inappropriate hospital utilization.

If overutilization or underutilization continues in this vein, it will markedly increase the burden on these hospitals and adversely affect the delivery of health services to the Saudi population.

While several studies in different countries have described the problem of inappropriate utilization of hospital facilities, no previous studies in the Kingdom of Saudi Arabia appear to have discussed this issue other than the present study.

The ageing of the world’s population is causing an increase in the number of frail patients admitted to hospitals. In the absence of appropriate management and organisation, these patients risk an excessive length of stay and poor outcomes. To deal with this problem, the purpose of this paper is to propose a conceptual model to facilitate the pathway of frail elderly patients across acute care hospitals, focussed on avoiding improper wait times and treatment during the process.

The conceptual model is developed to enrich the standard flowchart of a clinical pathway in the hospital. The modified flowchart encompasses new organisational units and activities carried out by new dedicated professional roles. The proposed variant aims to provide a correct assessment of frailty at the entrance, a better management of the patient’s stay during different clinical stages and an early discharge, sending the patient home or to other facilities, avoiding a delayed discharge. The model is completed by a set of indicators aimed at measuring performance improvements and creating a strong database of evidence on the managing of frail elderly’s pathways, providing proper information that can validate the model when applied in current practice.

The paper proposes a design of the clinical path of frail patients in acute care hospitals, combining elements that, according to an evidence-based management approach, have proved to be effective in terms of outcomes, costs and organisational issues. The authors can, therefore, expect an improvement in the treatment of frail patients in hospital, avoiding their functional decline and worsening frailty conditions, as often happens in current practice following the standard path of other patients.

The framework proposed is a conceptual model to manage frail elderly patients in acute care wards. The research approach lacks application to real data and proof of effectiveness. Further work will be devoted to implementing a simulation model for a specific case study and verifying the impact of the conceptual model in real care settings.

The paper includes suggestions for re-engineering the management of frail elderly patients in hospitals, when a reduction of lengths of stay and the improvement of clinical outcomes is required.

This paper fulfils an identified need to study and provide solutions for the management of frail elderly patients in acute care hospitals, and generally to produce value in a patient-centred model.

The purpose of this study is to explore the patterns of referral, reasons for admission or discharge from acute medical assessment/admission units (AMAUs) and the reasons for longer length of stay.

Details relating to consecutive patients were noted on a proforma by medical and nursing staff and were recorded over a three‐month period in 1638 patients. These included evidence of chronicity of disease, level of independence and recent contact with primary care services.

Age is an important factor in deciding admission or discharge. There is evidence that an opportunity for early intervention, to prevent admission, exists in a significant proportion of patients.

There is a need to develop a more integrated health care system to provide a more co‐ordinated approach to acute medical patients needs, keeping people in their own homes whenever possible.

The increasing number of acute medical admissions provides a challenge throughout the UK. This paper delineates the problem in a typical District General Hospital (DGH) and discusses approaches to decrease admission whilst improving patient care.

The purpose of this paper is to examine and explicate the concept of poor care by exploring what it is and what contributes to its occurrence in practice with a particular focus on the care of older people.

The results of systematically searched published literature were analysed using an inductive, descriptive, thematic approach as part of Rodgers’ evolutionary concept analysis method.

The concept of poor care is understood in the context of the antecedents of vulnerability, use of healthcare services and interaction with healthcare personnel. Its defining characteristics involve individual’s personal traits, interpersonal dynamics, an endangered self, misconceptions or organisational constraints.

Further research is needed to explore the recognition of poor care and reporting thresholds. In addition, the role of the “zone of tolerance” of expectations in the delivery and receipt of interpersonal care and attention for older people needs to be better understood.

Understanding the continuum and mapping the structures of poor care in contemporary UK healthcare practice can help sensitise practitioners to the widespread range and potential for instances of poor care. This concept analysis uniquely demonstrates consequences not only for the patient but also for healthcare staff and other individuals.

The purpose of this paper is to report on the use of an innovative peer review approach to identifying and addressing the causes of inappropriate admissions from hospital to nursing homes in South Gloucestershire (SG). It explains the methodology that was developed, the findings of the peer review process and reflects on the effectiveness of the process.

The peer review consisted of two stages. The first stage involved a panel of local stakeholders carrying out an audit of a random selection of cases where people had been assessed as needing permanent nursing or residential care. From this four cases of inappropriate admissions were identified. Stage two involved an externally facilitated process with two peer challenge panels; one of local stakeholders and the other external experts. The two panels analysed the cases of inappropriate admissions, identified the system causes and suggested actions to tackle the issues which were fed back to an audience of local stakeholders.

The combination of case audit and peer review was successful in providing robust challenge to the processes in SG by identifying shortcomings in the system and suggesting actions to improve outcomes.

The approach was taken in one Council area and therefore may not be replicable in another area.

The case study suggests that a peer review approach using both local and external peers, including providers, is an effective way to identify weaknesses in the health and social care processes. The insights offered by external peers and providers is helpful for councils in identifying where to focus resources and suggests that other areas should consider proactive adaptations to the peer review methodology that is offered as part of the LGA’s programme of sector-led improvement.

The case study suggests that a peer review approach could have a positive impact on the quality of care and quality of life for older people who are admitted to hospital.

The case study offers an innovative and original use of the peer review approach in social care that can be shared with other councils and partners. The Southwest Improvement Board have identified it as of particular interest to other areas seeking to work with partners to identify and implement positive change.