Unplanned admissions and the organisational management of XXXX : a multicentre ethnographic, qualitative study.

@entity1 @entity712
OBJECTIVES: @entity712 is a common cause of unplanned hospital admissions but there is little evidence on why, despite evidence-based interventions, admissions occur. This study aimed to identify critical points on @entity1 pathways where risk of admission is increased and identify barriers to the implementation of evidence-based interventions. DESIGN: Multicentre, longitudinal, @entity1 -led ethnography. SETTING: National Health Service settings across primary, community and secondary care in three geographical locations in England, UK. @entity1 : 31 @entity1 with severe or difficult to manage @entity712 followed for up to 11   months; 9 carers; 55 healthcare professionals. RESULTS: Fragmentation of healthcare, inequitable provision of services and poor continuity of care presented barriers to interventions for @entity712 . Critical points where a reduction in the risk of current or future admission occurred throughout the pathway. At the beginning some @entity1 did not receive a formal clinical diagnosis, in addition @entity1 lacked information about @entity712 , self-care and knowing when to seek help. Some clinicians lacked knowledge about diagnosis and management. Misdiagnoses of symptoms and discontinuity of care resulted in unplanned admissions. Approaching end of life, @entity1 were admitted to hospital when other options including palliative care could have been appropriate. CONCLUSIONS: Findings illustrate the complexity involved in caring for @entity1 with @entity712 . Fragmented healthcare and discontinuity of care added complexity and increased the likelihood of suboptimal management and unplanned admissions. Diagnosis and disclosure is a vital first step for the @entity1 in a journey of acceptance and learning to self-care/monitor. The need for clinician education about @entity712 and specialist services was acknowledged. @entity1 education should be seen as an ongoing 'conversation' with trusted clinicians and end-of-life planning should be broached within this context.
