adult hospital at home service sue gibbs 27 th march 2014
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Adult Hospital at Home Service Sue Gibbs 27 th March 2014. The Pilot. Pilot started end of October 2013 and ends March 31 st 2014 Opportunity to: - test the concept - Describe what patients thought about the service - Decide on the development of the service. - PowerPoint PPT PresentationTRANSCRIPT
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Adult Hospital at Home Service
Sue Gibbs27th March 2014
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The Pilot
• Pilot started end of October 2013 and ends March 31st 2014
• Opportunity to:
- test the concept
- Describe what patients thought about the service
- Decide on the development of the service
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The Patient Storywho will benefit from this service
• Mrs L is a 93 year old grandmother with a history of falls and comes to ED often and is frequently admitted
• In hospital she becomes very dependent
• In the Hospital at Home service the cause of falls was discovered and resolved simply & quickly
• Marked increase in Mrs L’s independence was noticed when she arrived home. Confidence and mobility improved in familiar surroundings and she quickly adopted the carer role for her 3 year grandson
• Discharged from the service back to the GP – no more unplanned visits to the hospital
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Increased confidence in
ability to manage own
condition
Value Added
BenefitsSome patients want to recover in
their own home
Greater Family
involvement
Liked the continuity of
care
Ensure all agencies in
place on discharge
From the patient feedback
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• Service hours 7 days 8am – 8pm
• Run by Registered Nurses Therapist Pharmacist Administrator
Description of the service
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The Pilot – lessons learnt
Small numbers of patients
•Identified the type of patients that the service can manage
•Review of policies to widen entrance criteria e.g. infection control policy
•Identified some of the barriers
– Clinical issues
– Home environment
•50% of the bed days were transferred out of the hospital.
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Future Plan
• Same continuum of patients as ambulatory care
• Trying to achieve the same objective –admission prevention and early transfer in a virtual ward
• Integrate the service with ambulatory care
• Services are designed around the needs of the patients
• From April 2014 – opening of the new Ambulatory Care unit
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Ambulatory Care and Virtual Ward
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Ambulatory Emergency Care Service
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The clinical model Consultant-led service
Integrated between Acute Medics & EDSurgical pathways also now being implemented
Integrated with virtual ward matrons as part of the core team
Open 7 days a week
Direct access provided to GP’s via a bleep
Providing a safe alternative to the traditional emergency care pathway and avoiding admissions
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Who is seen?
With the relocation of the Dorothy Warren Day Hospital to sit alongside ambulatory care, the aim is to offer an integrated frailty service for the more vulnerable, elderly cohort of patients with comprehensive geriatric assessments and therapy input available as well.
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Access to the service
Aimed at avoiding hospital admissions as well as reducing length of stay, referrals into the service come from various sources. The biggest referrers being ED (47%) and GP’s (37%).
Patients can be referred to ambulatory care in advance (i.e.) previous day or may be referred on the day (i.e.) diverted from ED or direct from GP’s.
Data: 01/12/2013-28/02/2014 inclusive
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What presents to AEC?The service is not pathway driven aiming to consider all suitable patients, to ensure the most vulnerable patients do not miss out
Pneumothorax Malaria
DVT
Pyleonephritis
Pneumonia
PE COPDCellulitis
Surgical abdominal pain
HIV
Jaundice
Pleural Effusion
Renal Colic
A few examples of conditions…
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Number of attendances
Since the service launched in February 2012, there has been a marked increase in the number of attendances to Ambulatory Care.
0
100
200
300
400
500
600
700
800
900
Oct
-11
Dec
-11
Feb
-12
Apr
-12
Jun-
12
Aug
-12
Oct
-12
Dec
-12
Feb
-13
Apr
-13
Jun-
13
Aug
-13
Oct
-13
Dec
-13
Feb
-14
Vo
lum
e o
f Am
bula
tory
Car
e at
ten
dan
ces
Activity Plan
Diverting patients directly away from the Emergency Department is a key part of the service – this is something with extended opening hours we have been able to increase, and with more capacity in a dedicated centre we hope to increase on the day referrals both from ED and GP’s
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Impact so far…
We have seen a reduction in the average length of stay and inpatient bed days for medical ambulatory care conditions, something we hope to build further on. With the introduction of surgical pathways, we also hope to have an impact on surgical conditions too.
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•Whittington HealthMagdala AvenueLondonN19 5NF Tel: 020 72883070
Fax: 020 7288 5550Website: www.whittington.nhs.uk