Adult Hospital at Home Service

Sue Gibbs27th March 2014

The Pilot

• Pilot started end of October 2013 and ends March 31st 2014

• Opportunity to:

- test the concept

- Describe what patients thought about the service

- Decide on the development of the service

The Patient Storywho will benefit from this service

• Mrs L is a 93 year old grandmother with a history of falls and comes to ED often and is frequently admitted

• In hospital she becomes very dependent

• In the Hospital at Home service the cause of falls was discovered and resolved simply & quickly

• Marked increase in Mrs L’s independence was noticed when she arrived home. Confidence and mobility improved in familiar surroundings and she quickly adopted the carer role for her 3 year grandson

• Discharged from the service back to the GP – no more unplanned visits to the hospital

Increased confidence in

ability to manage own

condition

Value Added

BenefitsSome patients want to recover in

their own home

Greater Family

involvement

Liked the continuity of

care

Ensure all agencies in

place on discharge

From the patient feedback

• Service hours 7 days 8am – 8pm

• Run by Registered Nurses Therapist Pharmacist Administrator

Description of the service

The Pilot – lessons learnt

Small numbers of patients

•Identified the type of patients that the service can manage

•Review of policies to widen entrance criteria e.g. infection control policy

•Identified some of the barriers

– Clinical issues

– Home environment

•50% of the bed days were transferred out of the hospital.

Future Plan

• Same continuum of patients as ambulatory care

• Trying to achieve the same objective –admission prevention and early transfer in a virtual ward

• Integrate the service with ambulatory care

• Services are designed around the needs of the patients

• From April 2014 – opening of the new Ambulatory Care unit

Ambulatory Care and Virtual Ward

Ambulatory Emergency Care Service

99

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The clinical model Consultant-led service

Integrated between Acute Medics & EDSurgical pathways also now being implemented

Integrated with virtual ward matrons as part of the core team

Open 7 days a week

Direct access provided to GP’s via a bleep

Providing a safe alternative to the traditional emergency care pathway and avoiding admissions

1111

Who is seen?

With the relocation of the Dorothy Warren Day Hospital to sit alongside ambulatory care, the aim is to offer an integrated frailty service for the more vulnerable, elderly cohort of patients with comprehensive geriatric assessments and therapy input available as well.

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Access to the service

Aimed at avoiding hospital admissions as well as reducing length of stay, referrals into the service come from various sources. The biggest referrers being ED (47%) and GP’s (37%).

Patients can be referred to ambulatory care in advance (i.e.) previous day or may be referred on the day (i.e.) diverted from ED or direct from GP’s.

Data: 01/12/2013-28/02/2014 inclusive

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What presents to AEC?The service is not pathway driven aiming to consider all suitable patients, to ensure the most vulnerable patients do not miss out

Pneumothorax Malaria

DVT

Pyleonephritis

Pneumonia

PE COPDCellulitis

Surgical abdominal pain

HIV

Jaundice

Pleural Effusion

Renal Colic

A few examples of conditions…

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Number of attendances

Since the service launched in February 2012, there has been a marked increase in the number of attendances to Ambulatory Care.

0

100

200

300

400

500

600

700

800

900

Oct

-11

Dec

-11

Feb

-12

Apr

-12

Jun-

12

Aug

-12

Oct

-12

Dec

-12

Feb

-13

Apr

-13

Jun-

13

Aug

-13

Oct

-13

Dec

-13

Feb

-14

Vo

lum

e o

f Am

bula

tory

Car

e at

ten

dan

ces

Activity Plan

Diverting patients directly away from the Emergency Department is a key part of the service – this is something with extended opening hours we have been able to increase, and with more capacity in a dedicated centre we hope to increase on the day referrals both from ED and GP’s

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Impact so far…

We have seen a reduction in the average length of stay and inpatient bed days for medical ambulatory care conditions, something we hope to build further on. With the introduction of surgical pathways, we also hope to have an impact on surgical conditions too.

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•Whittington HealthMagdala AvenueLondonN19 5NF Tel: 020 72883070

Fax: 020 7288 5550Website: www.whittington.nhs.uk