The Midlothian Enhanced Rapid Response Team (MERRIT) has now been operational for over a year now, since starting in the summer of 2014.

This report shows some of the data collected in the last 12 months, starting from September 2014, for the Hospital at Home component of the team.

Once again, we thank NHS Lothian and Midlothian Council for their continued support - being part of a truly integrated service we believe is a key to ongoing success!

Hospital at Home Update Autumn 2015From the Midlothian Enhanced Rapid Response and Intervention Team

All referrals to:

0131 270 8890

The Hospital at Home team are part of the wider MERRIT service and aim to offer an alternative to hospital admission for frail older patients. Although designed as a service for the over 75s, many of our patients are younger than this and we are happy to discuss any potential patients via the referral number 0131 270 8890.

We can offer daily visits to patients to undertake assessment and observations, adjust medication, give advice and support to them and their families and to make recommendations on ongoing management. We can give intravenous medication when necessary, for example furosemide or once daily antibiotics and we can administer subcutaneous or intravenous fluids when appropriate. Our patients have access to the same range of Radiology and Cardiac Physiology testing that the traditional hospital inpatients do.

In fact, many patients do not require invasive management, but do benefit from the daily input from the highly trained nurse practitioners on the team. We've recently expanded the team and are in the process of recruiting an additional doctor to the team to help provide medical cover throughout the year.

The H@H Team:Consultant Physician:Dr Patricia Cantley

Nurse Practitioners:Maureen Lucas MackintoshSharon DempseyNancy WarneBrenda HalleyLaura Young

Clinical Support Worker:Keith Dowson

Administrator:Margaret Newlands

in addition to the fully integrated Rapid Response Team of OTs, Physios, Pharmacist, administrators and care workers.

Who are we and what do we do?

Autumn stats!Referrals to Hospital at Home Team Oct 14 - Sept 15

Referrals to the team have continued to increase over the last year. Most recently there has been an increase in referrals from the acute admissions unit at the Royal Infirmary.

Source of referral to Hospital at Home Team

We present here some statistics gathered over the last 12 months for interest and discussion.Over this period, 255 referrals were received and 225 patients "admitted" to our 10 bed "virtual ward".

Age of patients referred to H@H team Oct 14 - Sep 15

Referrals come predominantly from the GP practices around Midlothian. Sometimes the GP requests only the H@H service, but in many cases the full team is required, including therapists and carers. The exact needs for any individual can be determined by the duty worker receiving the phone call. The Penicuik practice at Imrie Place was the highest referring practice in the last 3 months - 26 patients from a total of 78 in July to Sept 2015.

Sex of patients referred to H@H team Oct 14 - Sep 15

Did we avoid a hospital admission?

data from Oct 14 - Sept 15

It is always a hard question to judge whether a patient has avoided an acute hospital admission by being admitted to our service. In this chart, a subjective judgement has been made that the patient would otherwise have required full inpatient assessment and treatment. However, in many cases it is less clear - with a number of patients who refuse acute admission, but who would almost certainly have become more unwell without intervention and needed emergency admission within a day or two of their initial refusal.Future research may help to clarify this issue. We look forward to participating in the National Multicentre Randomised Controlled Trial to help answer these key questions.

Reasons for referral to Hospital at Home Oct 14 - Sept 15

Reasons for referral to Hospital at Home tend to be mostly for the management of acute infections and also for the treatment and monitoring of cardiac and renal failure. We have, however, also dealt with a number of other conditions, including hepatic encephalopathy, intravenous fluid support in a post operative patient, deteriorating diabetic control, possible stroke, fast atrial fibrillation and investigation of possible malignancy amongst other conditions. In each case, an assessment of the risks and benefits of hospital admission versus home treatment are carefully weighed up in conjunction with the patient and their family's wishes and goals. Each day we review with the patient and their family whether home treatment is still the right option for them. Around 10% of patients are admitted to hospital from our service, mostly arranged by us to an appropriate ward for them.

If a patient is dying, we work closely with the local District Nursing and Palliative Care services, and aim to hand over care to these professionals for the intensive support they can provide in the final days of an illness. We also have a strong working relationship with the Community Hospital in Midlothian where we can admit patients for end of life care in a compassionate environment.

Patients are usually kept on our "virtual ward" for no more than a few days. We hope that by working with the Information and Statistics Division in the forthcoming months to have more precise data on this, and also on admission rates to acute care from our service.

The Future?

We are working increasingly closely with the Royal Infirmary Acute Admissions Unit to take people straight home who might otherwise have required admission. This has become possible in part because of the newly instigated Medicine of the Elderly daily ward round in that unit and we hope to see many more people able to benefit from an early discharge from hospital.

Other news from the team here is that this month (October 2015), the nurses have started to work full shift patterns to cover seven days a week and be available until 8pm each evening. This has already made a big difference to a number of people and we hope it will allow more referrals on Thursdays and Fridays that might otherwise have been turned away. We thank the geriatricians of South Edinburgh and East Lothian for their support in this and the provision of medical cover.

Any questions - do get in touch!

Email patricia.cantley@nhslothian.scot.nhs.ukor call in to see us upstairs in Bonnyrigg Health Centre.

And of course that number again:

0131 270 8890