London Journal of Primary Care, 2017 VOL. 9, NO. 2, 18–22 http://dx.doi.org/10.1080/17571472.2016.1211592
OPEN ACCESS
EVALUATED SERVICE IMPROVEMENT
The Guy’s and St Thomas’s NHS Foundation Trust @home service: an overview of a new service Geraldine A. Leea and Karen Titchenerb a
Department of Adult Nursing, Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, London, UK; bGuy’s and St Thomas’s Trust @home service, Walworth Clinic, London, UK
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.
KEYWORDS
Hospital in the home; community care; admission avoidance; early discharge
Why this matters to me With the chronic shortage pressure on inpatient beds, there is a need to change the model of care. Treating people in their homes allows this with a multidisciplinary team. The GSTT@home team are able to provide care for a wide variety of conditions and provide many treatments and receive referrals from many sources. These sources include the local hospitals (allowing for early and safe discharge), from general practitioners (avoiding hospital admissions) and from others including London Ambulance Service (reducing the burden on emergency departments). The @home provides care seven days a week and has proven to be both efficient and cost-effective. It also highlights the ability to move acute care from acute settings to the community. We hope that this model of care can be extended to other areas in the future.
Key message Care for acute episodes can be provided in people’s homes using a multidisciplinary approach.
Introduction
Hospital in the home literature
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.[1–5] 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.
Within 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. [6,7] With pressure on hospital beds, where appropriate
CONTACT Geraldine A. Lee
[email protected]
© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
London Journal of Primary Care
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. Hospital in the Home (HitH) was first described in 1958, when it was proposed that some of the clinical interventions performed in hospital could be undertaken within a person’s home.[9] Since then, many countries have created their own version of hospital in the home services and reported very positive results.[1–5] The aspects of HitH that have been evaluated include its safety, efficacy, patient satisfaction and cost. An early RCT examined the safety and patient/carer satisfaction comparing the effectiveness of treatment of acute illness at home and in hospital and found lower incidence of geriatric complications (in those over 65 years) including confusion, urinary and bowel complications in the HitH patient group compared to the hospital patient group (all p
OPEN ACCESS
EVALUATED SERVICE IMPROVEMENT
The Guy’s and St Thomas’s NHS Foundation Trust @home service: an overview of a new service Geraldine A. Leea and Karen Titchenerb a
Department of Adult Nursing, Florence Nightingale Faculty of Nursing & Midwifery, King’s College London, London, UK; bGuy’s and St Thomas’s Trust @home service, Walworth Clinic, London, UK
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.
KEYWORDS
Hospital in the home; community care; admission avoidance; early discharge
Why this matters to me With the chronic shortage pressure on inpatient beds, there is a need to change the model of care. Treating people in their homes allows this with a multidisciplinary team. The GSTT@home team are able to provide care for a wide variety of conditions and provide many treatments and receive referrals from many sources. These sources include the local hospitals (allowing for early and safe discharge), from general practitioners (avoiding hospital admissions) and from others including London Ambulance Service (reducing the burden on emergency departments). The @home provides care seven days a week and has proven to be both efficient and cost-effective. It also highlights the ability to move acute care from acute settings to the community. We hope that this model of care can be extended to other areas in the future.
Key message Care for acute episodes can be provided in people’s homes using a multidisciplinary approach.
Introduction
Hospital in the home literature
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.[1–5] 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.
Within 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. [6,7] With pressure on hospital beds, where appropriate
CONTACT Geraldine A. Lee
[email protected]
© 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
London Journal of Primary Care
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. Hospital in the Home (HitH) was first described in 1958, when it was proposed that some of the clinical interventions performed in hospital could be undertaken within a person’s home.[9] Since then, many countries have created their own version of hospital in the home services and reported very positive results.[1–5] The aspects of HitH that have been evaluated include its safety, efficacy, patient satisfaction and cost. An early RCT examined the safety and patient/carer satisfaction comparing the effectiveness of treatment of acute illness at home and in hospital and found lower incidence of geriatric complications (in those over 65 years) including confusion, urinary and bowel complications in the HitH patient group compared to the hospital patient group (all p
