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Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Research output: Contribution to journalArticle

Original languageEnglish
Number of pages13
JournalJournal of Health Services Research and Policy
Early online date5 Dec 2019
DateAccepted/In press - 1 Jun 2019
DateE-pub ahead of print (current) - 5 Dec 2019


Objective: To conduct a systematic review of the evidence for when a hospital admission for an older person can be
avoided in subacute settings. We examined the definition of admission avoidance and the evidence for the factors that
are required to avoid admission to hospital in this setting.

Methods: Using defined PICOD criteria, we conducted searches in three databases (Medline, Embase and Cinahl) from
January 2006 to February 2018. References were screened by title and abstract followed by full paper screening by two
reviewers. Additional studies were searched from the grey literature, experts in the field and forward and backward
referencing. Data were narratively described, and concept analysis was used to investigate the definition of admission

Results: A total of 17 studies were considered eligible for review; eight provided a definition of admission avoidance and
10 described admission avoidance criteria.We identified three factors which play a key role in admission avoidance in the
subacute setting: (1) ambulatory care sensitive conditions and common medical scenarios for the older person, which included
respiratory infections or pneumonia, urinary tract infections and catheter care, dehydration and associated symptoms,
falls and behavioural management and managing ongoing chronic conditions; (2) criteria/tools, referring to interventions
that have used clinical expertise in conjunction with a range of general and geriatric triage tools; in condition-specific
interventions, the decision whether to admit or not was based on level of risk determined by defined clinical tools and
(3) personnel and resources, referring to the need for experts to make the initial decision to avoid an admission.
Supervision by nurses or physicians was still needed at subacute level, requiring resources such as short-stay beds,
intravenous antibiotic treatment or fluids for rehydration and rapid access to laboratory tests.

Conclusion: The review identified a set of criteria about which ambulatory care sensitive conditions and common
medical scenarios for the older person can be treated in the subacute setting with appropriate tools and resources. This
information can help commissioners and care providers to take on these important elements and deliver them in a
locally designed way.

    Research areas

  • hospital admission, older people, systematic review

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    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Sage Publications at Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 239 KB, PDF document


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