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Improvement Hub Enabling health and social care improvement
Guiding Principles Prof Graham Ellis @grahamellis247 #HatHscot - - PowerPoint PPT Presentation
Guiding Principles Prof Graham Ellis @grahamellis247 #HatHscot - - PowerPoint PPT Presentation
Hospital at Home: Guiding Principles Prof Graham Ellis @grahamellis247 #HatHscot Improvement Hub Enabling health and social care improvement Is Hospital the wrong place? HAI 5% of admissions Functional Decline 30-56% after
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Is Hospital the wrong place?
- HAI
– 5% of admissions
- Functional Decline
– 30-56% after admission
- Patient Experience
– 90% prefer H@H
- Delirium
– 15% of Medical admissions > 65
- Carer strain
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Businesses are agile
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Health and Social Care Landscape
A range of policy imperatives and guidance provide a framework to support the design and delivery of community-based services, including:
- Public Bodies (Joint working) Scotland
Act 2014
- Community Health and Social Care
Integration Framework
- Programme for Government for
Scotland 2019/20
- Unscheduled Care 6 Essential Actions
- Realistic Medicine
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What does the research tell us?
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What is Hospital at Home?
Hospital at Home is acute, hospital-level care by healthcare professionals for a condition that would
- therwise require acute hospital inpatient care.
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Key features of Hospital at Home
- The severity of the condition managed.
- A hospital specialist acts as responsible
medical officer
- Urgent access to hospital-level diagnostics.
- It provides a different level of
interventions, such as access to IV fluids and oxygen.
- Short, time-limited acute episodes of
care.
- Delivered by multidisciplinary teams.
- Complements other community-based
health and care initiatives.
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Hospital at Home is not…
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Consultations
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Home visits
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Meds Rec
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Ward Rounds
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Which conditions can be managed?
Pneumonia Acute Atrial fibrillation Congestive cardiac failure Gastroenteritis Hyponatreamia and unstable metabolic conditions Acute Kidney Injury Pulmonary embolism and deep vein thrombosis Infected skin conditions such as cellulitis and infected ulcers Acute functional decline due to underlying medical conditions Upper limb fractures after initial assessment Exacerbations of COPD and Asthma Acutely unwell nursing home patients
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What does Hospital at Home provide?
- Standardised acute assessment
a clinical history physical examination, medicines reconciliation functional assessment assessment tools
- Diagnostics
urgent bloods 12 lead Electrocardiogram (ECG) cardiology investigations: 24-hour ECG, Echo, ultrasound bladder endoscopy radiological tests: plain x-ray, ultrasound, CT scanning, MRI
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Early AHP
POC Diagnostics
Interventions at point of care
Oxygen Nebulisers Equipment Specialist Referrals IV Therapies Acute Prescribing
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Acute Conditions Senior Decision Making Daily Review Multidisciplinary Teams Interventions (e.g IV antibiotics) Diagnostics (Imaging etc)
What is Hospital at Home?
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Key interfaces
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Workforce, Workforce, Workforce
- Recruit for values
- Capable of learning
- Flexible
- Collaborative
- Diverse
- Support with training and
- pportunities
- Team dynamics are crucial
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Risks
Clinical Risk
Safety Clinical Guidelines
Performance
Additionality and efficiency Standard Operating Procedures
Costs
Variation in performance Management
Staffing
Recruitment and Retention Support and Training
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Leadership and governance
A key role for senior leaders is to create the conditions for transformational change, including collective leadership across sectors to establish a culture of collaboration focused on local population need.
Service protocols or standard operating procedures Clear accountability A supportive culture for innovation An embedded culture of reflection and learning Clear links to local governance reporting structures A realistic medicine approach
In order to run a safe and effective Hospital at Home service, the following should be in place:
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UK Hospital at Home Society
First UK Hospital at Home Society meeting 8th October 2020 University of Birmingham Virtual Summit 5th March 2020 14:00 details at www.hospitalathome.org.uk Abstract submissions open!
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