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
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