Review of Care-Home Resident Hospital Admissions and Prevention opportunitiesat the Frailty unit, Gloucestershire Royal Hospital

Introduction: Hospital admissions from care homes are frequent, particularly among frail older adults. While many are clinically necessary, others might be avoided with timely community interventions and advanced care planning. Unplanned admissions can distress residents, disrupt continuity of care, and increase demand on acute services. The Frailty Unit at Gloucestershire Royal Hospital serves as the primary point of admission for this population. Understanding admission patterns and opportunities for community management is crucial to improving patient outcomes and system efficiency.
 

Methods: This retrospective descriptive study reviewed consecutive care home admissions to the Frailty Unit between April and June 2025, using a quality-improvement dataset. Variables included demographics, Charlson Comorbidity Index (CCI), presenting complaint, diagnosis, hospital interventions, outcomes, presence of ReSPECT forms, use of the Cinapsis advice line, suitability for Rapid Response management, and discharge processes.
 

Results: Fifty-seven residents were included (mean age 86.2 years, range 70–99; mean CCI 7.2). ReSPECT forms were present for 95%. Common presenting issues were falls, breathlessness, and confusion; primary diagnoses included community-acquired and aspiration pneumonia, and postural hypotension. Median length of stay was 2.1 days, and in-hospital mortality was 15.8%. Retrospective assessment found 40% of cases potentially suitable, and a further 18% possibly suitable, for community-based Rapid Response management. Cinapsis was used in 19% of cases; discharge was smooth in 79%.
 

Conclusions: A significant proportion of care home admissions may be preventable through improved community-based care. Key priorities include improving falls prevention, earlier detection of infections and low oxygen levels, improved support for swallowing difficulties and nutritional support in the community, expanded Rapid Response services, optimised use of ReSPECT plans, and strengthened advice available before hospital admission. Together, these steps can help deliver more person-centred and efficient care for frail older residents.