Improving specialised care for neuromuscular patients reduces the frequency of preventable emergency hospital admissions
Section snippets
1. Introduction
In the UK, it has been estimated that 71,000 people have a neuromuscular disease (NMD) many of which have a progressive course leading to significant disability with multi-system involvement; such patients require life-long specialised multi-disciplinary care. However, several reports indicate that access to specialised neuromuscular services is variable and patient satisfaction for hospital services could be improved [1], [2], [3]. In the United Kingdom in recent years emergency hospital
2.1. Audits
Two cross-sectional case note review audits were conducted across the following National Health Service (NHS) specialised commissioning groups: London, South East Region, Wessex, South East Coast and East of England, in 2011 and in 2017. All of the Hospital Trusts in these regions were invited to take part. The project was registered and approved by the internal review boards for each of the participating organisations. Informed consent was not required, and all data were anonymised; any
3. Results
Table 2 summarises the participating hospitals (there were 12 in A1 and 9 in A2) and also outlines the acute attending services involved in emergency NMD admissions. The population demographics were comparable in both audits: 54% men and 45% women (unknown: n = 1) in A1, with a median age of 61 years (range 0–96); in A2, 55% men and 45% women, with a median age of 55.5 years (range 0–94). In A1 there were 576 unplanned admissions in 395 patients, and in A2 there were 361 admissions in 314
4. Discussion
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 [15],[16]. 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.
The results of A1 identified risk factors for preventable unplanned
5. Conclusions and implications
We have undertaken the largest reported NHS audits of emergency hospital admissions in patients with NMD in England. Our results show significant improvement in the reduction of preventable emergency admissions for people with NMD over a 5 year period. Interventions that have contributed to this improvement include: increased proportion of NMD patients known to specialised neuromuscular centres with co-ordination of multi-disciplinary care by specialised centres, better links and improved
Acknowledgements
The authors would like to thank all those from the participating Trusts who helped with both audits, particularly the staff who arranged honorary contracts for the clinical research associates, assisted with the audit registration, arranged the medical notes access and booked rooms for the audit visits, which were previously mentioned in both audits and technical reports. The authors are particularly grateful to Muscular Dystrophy UK (Funded the second audit); Mr Bobby Ancil and Mr Nic Bungay
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