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Clinical Updates

Nearly half of all emergency admissions to hospital from care homes could be avoided

Better working relationship GPs and the upskilling of care home staff could be the answer.



Elderly Emergency Room

Chest infections, pressure sores and urinary tract infections were some of the primary reasons for admission.

A joint initiative between NHS England and the Health Foundation has found that more than around 40% of emergency admissions to hospital involving care home residents could be potentially avoided.

The analysis comes as the NHS rolls out the Enhanced Health in Care Homes (EHCH) project to improve residents’ health and reduce avoidable emergency admissions.


Conditions such as chest infections, pressure sores and urinary tract infections were found to be some of the primary reason for hospital admissions.

The ThinkTank claims that a better working relationship GPs, hospitals, community services and care homes alongside upskilling care home staff to deliver a wider variety of care could be the answer.

Four pilot sites for the project showed a decrease in potentially avoidable emergency admissions to hospital of up to 27%, decreases in emergency admissions of up to 23% or reductions in A&E visits of up to 29% from care home residents.

Hospitals not the best place for the elderly.

The Royal College of Nursing says that currently care home staff are often left with “few options” but to call an ambulance for clients.

Wendy Preston, RCN Head of Nursing Practice, said: “Nursing staff in care homes want more than anyone to try and prevent the residents they care for from being admitted to hospital as emergencies.

“But, at present, if a care home resident has a fall or develops a urinary tract infection (UTI), particularly out of hours, staff have very few options and are often advised to call an ambulance by NHS 111 or managers.

“What is needed are dedicated primary care teams including advanced practice nurses who can promptly assess and treat residents who fall ill or injure themselves – a few areas currently have such teams, but we need them to be rolled out nationwide.

“Hospital is not the best place for most frail elderly people and nurses are often the solution to this problem despite services not always receiving the correct funding.”

The best possible quality of life.

NHS England claims the project could also see the quality of life of hundreds of thousands of residents.

Professor Alistair Burns, National Clinical Director for Dementia and Older People’s Mental Health at NHS England, said: “People want to know their mum or grandad is being properly looked after and helping them to live well and with the best possible quality of life is key to that.

“That’s why we are rolling out extra support to care homes as part of the Long Term Plan to reduce unnecessary medication and strengthen the ties between GPs and care homes.

“In some of the vanguard areas, which today’s report with the Health Foundation shows, these measures made a huge difference to residents’ health and when fully rolled out they will mean older people in every part of the country will benefit from personalised, specialist support in their care home.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.



Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.


Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 




A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.


Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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