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 admission • Patient Experience – 90% prefer H@H • Delirium – 15% of Medical admissions > 65 • Carer strain
Businesses are agile
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
What does the research tell us?
What is Hospital at Home? Hospital at Home is acute, hospital-level care by healthcare professionals for a condition that would otherwise require acute hospital inpatient care.
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.
Hospital at Home is not…
Consultations
Home visits
Meds Rec
Ward Rounds
Which conditions can be managed? Pneumonia Acute Atrial fibrillation Congestive cardiac failure Gastroenteritis Hyponatreamia and unstable Acute Kidney Injury metabolic conditions Pulmonary embolism and deep Infected skin conditions such as vein thrombosis cellulitis and infected ulcers Acute functional decline due to Upper limb fractures after underlying medical conditions initial assessment Exacerbations of COPD and Acutely unwell nursing home Asthma patients
What does Hospital at Home provide? • • Standardised acute assessment Diagnostics a clinical history urgent bloods physical examination, 12 lead Electrocardiogram (ECG) medicines reconciliation cardiology investigations: 24-hour ECG, Echo, functional assessment ultrasound bladder assessment tools endoscopy radiological tests: plain x-ray, ultrasound, CT scanning, MRI
Interventions at point of care Early Nebulisers AHP IV Equipment Therapies POC Acute Prescribing Diagnostics Specialist Oxygen Referrals
What is Hospital at Home? Acute Conditions Senior Diagnostics Decision (Imaging etc) Making Interventions Daily Review (e.g IV antibiotics) Multidisciplinary Teams
Key interfaces
Workforce, Workforce, Workforce • Recruit for values • Capable of learning • Flexible • Collaborative • Diverse • Support with training and opportunities • Team dynamics are crucial
Risks Clinical Clinical Risk Safety Guidelines Standard Additionality Performance Operating and efficiency Procedures Variation in Costs Management performance Recruitment Support and Staffing and Training Retention
Leadership and governance A key role for senior leaders is to create the In order to run a safe and effective conditions for transformational change, Hospital at Home service, the following including collective leadership across sectors to should be in place: 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
UK Hospital at Home Society First UK Hospital at Home Society meeting 8 th October 2020 University of Birmingham Virtual Summit 5 th March 2020 14:00 details at www.hospitalathome.org.uk Abstract submissions open!
Keep in touch hcis.livingwell@nhs.et @ihubscot To find out more visit ihub.scot/hospital-at-home www.hospitalathome.org.uk
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