Abstract
Hospital in the home is a relatively new concept within the UK healthcare system. The Guy’s and St Thomas’s NHS Foundation Trust (GSTT) @home service ‘Bringing hospital care to your home’ was commissioned by Lambeth and Southwark CCG in 2014 to provide acute care in the patients’ place of residence by facilitating rapid discharge from hospital. The service is designed for 260–280 referrals each month from local hospitals, London Ambulance Service, GPs, district nurses and palliative care services. The GSTT@home provides intensive care for a short episode through multidisciplinary team work with the aim of returning the patient to their prior health status following an acute episode of ill health. The main criteria for referrals are adults, living within Lambeth or Southwark with an acute onset of illness often with acute exacerbations of chronic conditions. Care is delivered using 25 clinical pathways using integrated care teams, including those for respiratory disease, heart failure and palliative care services. Recently, the service extended to include overnight palliative care. As care shifts from hospital to the community, it is envisaged that these types of programmes will become an essential component of care provision. This paper describes the service and presents initial service evaluation data.
Highlights
Hospital in the home is a relatively new concept within the UK healthcare system despite being an established method of delivering community based care in several countries.[1,2,3,4,5] This paper will provide an overview of the relatively new Guy’s and St Thomas’s NHS Foundation Trust (GSTT) @home and describe how the service has evolved since its inception.Hospital in the home literatureWithin the NHS, the last few years has seen unprecedented demands on the service due to an ageing population and multiple co-morbidities
Its primary aim was to facilitate the rapid discharge from accident and emergency departments, acute assessment units and acute wards by allowing patients to be discharged from hospital earlier or avoiding patients being admitted to hospital
The main reasons for referral were: COPD exacerbation (22%), IV therapy (23%), heart failure (16%), urinary tract infections (13%), falls (5%), community acquired pneumonia 5%, diabetes 2% and blood monitoring for acute kidney infection and INR, 10%
Summary
Hospital in the home is a relatively new concept within the UK healthcare system despite being an established method of delivering community based care in several countries.[1,2,3,4,5] This paper will provide an overview of the relatively new Guy’s and St Thomas’s NHS Foundation Trust (GSTT) @home and describe how the service has evolved since its inception.Hospital in the home literatureWithin the NHS, the last few years has seen unprecedented demands on the service due to an ageing population and multiple co-morbidities. With 11 million people over 65 years and four million people with a long-term illness in the UK, many patients require regular healthcare in both acute and community settings. Titchener emergency department (ED) staff try to discharge older patients with long-term illnesses back into the community for further management and avoid a scenario known as ‘bed or access block’ (i.e. lack of social support or inability to self-care at home).[8] A King’s Fund report noted the challenges of caring for older people and the complexity involved in assuring the availability of community services, access to hospital services and the relationships between the various services and their staff.[8] The report highlighted the need for better alignment of primary, community and acute care to reduce avoidable hospital admissions and length of hospital stays. One of the solutions to reduce hospital bed use is a ‘hospital in the home’ model that allows patients to return home and receive short-term treatment in a familiar environment
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