Hospital at Home

in

Claire Steel Lanarkshire population approx. 600,000

Started December 2011

University Hospital Monklands (24)

Then University Hospital Wishaw 72 Virtual (24) (excluding ) beds

Then University Hospital Hairmyres (24) Pathways Physiothera Advanced Home- py Practitioner care as Skills Consultant required Geriatrician Occupation al Therapy

Support from Social Nursing Work Digital records Hospital Paperwork Mental Health Nurse Prescribing Nursing support Including IVs Staff Access to Emergency Phamacy Diagnostics Daily Virtual Ward Rounds Physiothera Advanced Home- py Practitioner care as Skills Consultant required Geriatrician Occupation al Therapy COMPREHENSIVE Support from Social Nursing Work GERIATRICDigital records Hospital Paperwork ASSESSMENTMental Health Nurse Nursing Prescribing support Staff Access to Emergency Pharmacy Diagnostics Daily Virtual Ward Rounds Referral criteria

• Predominantly for over 75 but will see under 75 if frail

• Exclusion criteria:

Chest pain, stroke, acute surgical or orthopaedic

Types of patients :

COPD, heart failure, infections, delirium, falls End of life, ACP discussions, Referrals

Ward A and GP SAS discharge E Open: 8-8 (mon – sun) New referrals: 8-4 (mon – fri) Weekends – will take NH referrals HOSPITAL AT HOME Last month: UHM – 103 New patients 140 UHH – 89 124 120 120 112 106105 108 106 96 99 96 UHW– 61 100 92 95 88 90 91 88 91 90 88 85 87 84 79 81 80 80 68 67 65 66 61 58 60 55 53 55 54 40 40

20

0 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 79% managed at home

17053 referrals Dec 2011 to January 2020

13618 supported at home

Patients Supported at home % 100

92 90 92 90 88 87 8587 87 87 84 84 8283 82 83 80 80 79 80 80 80 77 7879 78 79 7576 76 7576 75 7374 70 65 60

50

40

30

20

10

0 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Staffing

38 72

• Admin staff • APRs (band 4) • Nurse (band 5) • CPN (covers 3 sites) • Advanced practioners (band 6) (nurse, physio or OT) • Consultant geriatrician • Cross cover as required (missing pharmacy input) Challenges • Communication - 1. managing and communicating risk 2. Communication between H@H and primary care 3. HSCPs – North and South, 4. POC issues

• Referrals 1. Inappropriate referrals 2. Missing referrals from wards/A and E

• Medication – 1. Meds rec communication 2. Blister packs 3. Lack of pharmacy input

• Travelling – 1. geographical spread 2. Parking 3. weather What works well • Enthusiastic

• Forward thinking

• Flexible team

• Blurring of roles

• Multidisciplinary team all in one office

• Great communication within the team

• Keeps people out of hospital

• Patients and families like it Research

Research Partners: Research Projects:

• University of Oxford x 2 • Randomised Controlled Trial UK Wide • University of West of • Qualitative feedback from • Caledonian patients and carers University • Cost effectiveness evaluation Research papers • Qualitative evaluation of • 4 and counting... working methods Innovation

• Point of care testing

• Remote monitoring

• Video calling

• Digital records and mobile access

• Ongoing QI work with medication reconciliation Team Lanarkshire

Oh I felt as if I was the queen getting all that attention!

It was like This is the way healthcare the Cavalry should be coming over the hill...