Trudi Marshall/ Claire Ritchie Nurse / AHP Consultant Older People NHS Lanarkshire May 2016 LANARKSHIRE Hospital at Home (H@H) TEAM
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 Social Work Primary Care Admission Avoidance Hospital at Home Treatment in the patients own home Would otherwise require admission to hospital Always for a limited time Secondary Care 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
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 PT: Cannot do stairs OT: Needs equipment Med: Needs dig stabilised OT: Needs homecare Nurse: Needs transport A&E Medical Receiving Unit Discharge? 12:00pm Arrives in A&E/ Assessment Unit Sees triage nurse, initial assessment, observations, social history 13:00pm Sees FY1 Clinical history, social history, physical examination, Bloods, CXR and ECG ordered, waits on trolley 15:00pm Sees FY2 Clinical assessment, social history, physical examination, initial management plan, CXR and ECG reviewed, transferred to bedded 16:00pm Sees Consultant Case presented Bloods, CXR and ECG reviewed Medication reviewed, Management plan
A DIFFERENT PATH?
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 LOS 5 Days 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, Case reviewed daily Bloods reviewed Physio reviews mobility, OT assess equipment and homecare needs, rehab given, family updated, case handed back to primary care
HOSPITAL @ HOME Patients accepted by in 29 Months 2,864 76 % Supported at Home 76% are managed in their own home instead of Hospital by the H@H Team Male 41% Female 59% 13 % Known to DNs 13% are known to DNs prior to being seen by H@H Team 5.7 days Length of Stay 5.6 / Day 19 % Known to SW Only 19% of patients are known to SW at the time of their presentation to H@H Team
HOSPITAL @ HOME RIP 30 Day Mortality 8% Beds Closed 50 40% UWS Percentage of Monklands DME Patients (estimate) are Hospital @ Home Qualitative Evaluation by University West of Scotland Financial Evaluation
It was like the Cavalry coming over the hill... P1 believed that this was the most thorough assessment that she had ever experienced And no danger of some of these awful hospital bugs. Oh I felt as if I was the queen getting all that attention sometimes it s easier to get into hospital than it is getting out This is the way healthcare should be I think it is amazingly impressive They were marvellous, absolutely marvellous I think just being in your own surroundings makes you feel happier and more confident and able to cope. 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
Seamless clinical pathway that is patient centric rather than service centric Integration with social care safe, effect, cost effective person centred Closed beds Social Work Homecare Community Rehab Community Nursing H@H Hospital GPs