Alternatives to hospital care: what are they and who should decide?

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Abstract
Objective: To examine potential for alternatives to care in hospitals for acute admissions, and to compare the decisions about these alternatives made by clinicians with different backgrounds. Design: Standardised tool was used to identify patients who could potentially be treated in an alternative form of care. Information about such patients was assessed by three panels of clinicians: general practitioners without experience of general practitioner beds, general practitioners with experience of general practitioner beds, and consultants. Setting: One hospital for acute admissions in a rural area of the South and West region of England. Subjects: Of 620 patients admitted to specialties of general medicine and care of the elderly, details of 112 were assessed by panels. Main outcome measures: Proportion of hospitalised patients who could have received alternative care and identification of most appropriate alternative form of care. Results: Both general practitioner panels estimated that between 51 and 89 of the hospitalised patients could have received alternative care (equivalent to 8-14% of all admissions). Consultants estimated that between 25 and 55 patients could have had alternative care (5.5-9% of all admissions). General practitioner bed and urgent outpatient appointment were the main alternatives chosen by all three panels. Conclusion: About 10% of admissions to general hospital might be suitable for alternative forms of care. Doctors with different backgrounds made similar overall assessments of most appropriate forms of care.