LANARKSHIRE

Hospital at Home

(H@H) TEAM

Trudi Marshall/ Claire Ritchie

Nurse / AHP Consultant Older People

NHS Lanarkshire

May 2016

Opportunism

Adverse

consequences of

hospital admission

• 12% of patients decline in ADL function

between admission and discharge

• Delirium after admission 4-29%

• 500 patients/ year fracture hip in hospital

in England and Wales

• Hospital acquired infections (5-10%)

• One or more adverse drug reaction in19%

of inpatients

HOSPITAL @ HOME

Secondary Care

Primary

Care Social

Work

Admission Avoidance Hospital at Home • Treatment in the patients own home

• Would otherwise require admission to

hospital

• Always for a limited time

Reduced Mortality at 6/12 Reduced Costs Increased Satisfaction

Shepperd S, Doll H, Angus RM, Clarke MJ, Iliffe S, Kalra L, Ricauda NA, Wilson AD. Hospital at home admission avoidance. Cochrane Database of Systematic Reviews 2008

Lanarkshire

Lanarkshire Population 653,310

Over 65s pop 57,100

18 % in most deprived data zones

28% increase over 75s by 2024

48% increase over 75s by 2034

Current over 65 population covered by H@H 34,891

Approx 60 active patients each day

Average 15 new patients assessed at home each day

H@H criteria

Inclusion Criteria

Over 65 years, NH Residents of all ages

*younger age range accepted if frailty present

Exclusion Criteria

Stroke

Chest Pain

"DVT"

Clear fracture

Clear surgical abdomen

Timescales

• January 2012 rollout -

Northwest Unit

• April 2015 rollout - East

Kilbride and Hamilton

• November 2016 rollout – North

East unit

Still to rollout

• Clydesdale

• Rutherglen and Cambuslang

THE TEAM

CASE STUDY

81 yr man

lives with elderly wife

bedroom upstairs

Multiple pathology

Known CCF

Breathlessness, reduced

mobility

A&E

12:00pm Arrives in

A&E/ Assessment

Unit

Sees triage nurse,

initial assessment,

observations, social

history

Medical

Receiving Unit

13:00pm Sees FY1

Clinical history, social

history, physical

examination, Bloods,

CXR and ECG

ordered, waits on

trolley

Discharge?

15:00pm Sees FY2

Clinical assessment,

social history, physical

examination, initial

management plan, CXR

and ECG reviewed,

transferred to bedded

area

16:00pm Sees

Consultant

Case presented

Bloods, CXR and ECG

reviewed

Medication reviewed,

Management plan

PT:

Cannot do stairs

OT: Needs

equipment

Med:

Needs dig stabilised

OT: Needs

homecare

Nurse:

Needs transport

10:00am GP Visits at home

Patient has:

Chest Infection

Uncontrolled AF

Evidence of Heart Failure

Unable to walk more than 6 feet

GP calls ERC admits to hospital

LOS 10

Days

A DIFFERENT PATH?

10:30am ASSET

Practitioner arrives,

Clinical history, physical

examination, observations,

social history, bloods

taken, ECG, CX Ray if

needed, initial

management plan,

12:00am ASSET

Consultant arrives, Clinical

history, focused

examination, ECG

reviewed, management

plan and investigations

reviewed, medication

changed and prescribed,

10:00am GP Visits at home

Patient has:

Chest Infection

Uncontrolled AF

Evidence of Heart Failure

Unable to walk more than 6 feet

GP calls ERC for admission

Referral passed to H@H

Case reviewed daily

Bloods reviewed Physio

reviews mobility, OT

assess equipment and

homecare needs, rehab

given, family updated,

case handed back to

primary care

LOS 5

Days

HOSPITAL @ HOME

76

%

Supported at Home

76% are managed in

their own home instead

of Hospital by the H@H

Team

13

%

Known to DNs

13% are known to DNs

prior to being seen by

H@H Team

19

%

Known to SW

Only 19% of patients are

known to SW at the time

of their presentation to

H@H Team

2,864

Patients accepted by in 29 Months

5.6 / Day

5.7

days

Length of Stay

Male

41% Female

59%

HOSPITAL @ HOME

RIP 30 Day Mortality 8%

Beds Closed 50

UWS

Percentage of Monklands DME Patients are Hospital @ Home (estimate)

40%

Qualitative Evaluation by University West of Scotland

Financial Evaluation

They were

marvellous,

absolutely

marvellous

This is the

way

healthcare

should be

It was like the

Cavalry

coming over

the hill...

P1 believed

that this was

the most

thorough

assessment

that she had

ever

experienced

Well it was either

the hospital or being

in my own home…

there was no

choice. I mean who

would want to go to

hospital, when they

could be treated just

as well if not better

at home…

And no danger

of some of

these awful

hospital

bugs.

I think it is

amazingly

impressive

Oh I felt

as if I

was the

queen

getting all

that

attention

I think just being in

your own

surroundings makes

you feel happier and

more confident and

able to cope.

sometimes

it’s easier

to get into

hospital

than it is

getting out

•

Hospital

Community

Nursing

GPs

Community

Rehab

Social

Work

H@H

Homecare

Seamless clinical pathway that

is patient centric rather than

service centric

Integration with social care

safe, effect, cost effective

person centred

Closed beds