The provision of hospital at home care: Results of a national survey of UK hospitals

Abstract

Background Hospital at home (HaH) replicates elements of hospital‐based care in the community, to facilitate the safe management of a broad spectrum of acute illness in the patient's usual environment. The extent to which this model of care has been adopted in the United Kingdom is unknown. Methods The Society for Acute Medicine Benchmarking Audit is a day of care survey undertaken annually within the United Kingdom. Participation is open to all hospital in the United Kingdom receiving acutely unwell medical patients. A questionnaire is used to collect hospital‐level data on the structure and organisation of acute care delivery. The survey included questions designed to quantify the number of hospitals that offered HaH. When present, further questions were asked to clarify the characteristics of the HaH service in terms of workforce, range of diagnostic test and interventions. This information was used to build a picture of HaH service provision on a national scale. Results A total of 130 hospitals contributed organisational data to SAMBA19. The capability to refer to a hospital at home service was recognised by 46.9% (n = 61) of units. The majority of these services, 83.3% (n = 50) were nurse‐led. The capability to provide a physician review at home was reported in 23.3% (n = 14). The majority of services could provide intravenous antibiotics at home, but access to other simple interventions, such as intravenous diuretics or acute supplemental oxygen, is limited. Conclusion At present, few acute hospitals for consitency in the United Kingdom have access to a hospital at home service capable of replicating essential elements of inpatient care. Our study suggests organisational change in acute care delivery and significant investment would be required to establish equal access to hospital‐at‐home care within the United Kingdom

Hospital at Home for Intrathecal Pump Refills: A Prospective Effectiveness, Safety and Feasibility Study

“…The practical implementation of hospital at home outside a research context is often more difficult to achieve and would require organizational changes [35]. Specifically in this study, several environmental factors were mentioned, namely a low sitting couch (45%) and performing the refill while sitting on your knees (5%).…”

Possible futures of acute medical care in the NHS: a multispecialty approach

“…36 Although a wide range of acute medical conditions can be diagnosed and treated in the home, 37 this is not currently a widely developed or deployed model of care in the UK. 38 Physician-led acute 'hospital at home' care models show improved clinical outcomes for older adults with frailty when compared with in-patient admission, in particular reduced incidence of delirium and progression to institutional care. 38 For the NHS an average of over £2,000 per patient treated can be saved in this model.…”

“…38 Physician-led acute 'hospital at home' care models show improved clinical outcomes for older adults with frailty when compared with in-patient admission, in particular reduced incidence of delirium and progression to institutional care. 38 For the NHS an average of over £2,000 per patient treated can be saved in this model. 39,40 Their development is a dominant feature of acute care policy in the UK.…”

The Multidisciplinary Mobile Unit (MMU) Program Bringing Hospital Specialist Geriatric Competencies at Home: A Feasible Alternative to Admission in Older Patients with Urgent Complaints

“…Hospital-at-home programs are acute clinical services taking staff, equipment, technologies, therapies, and skills, usually provided in hospital, directly at the patient's own home [9][10][11][12][13]. These services generally substitute inpatient care after an initial diagnostic evaluation, which can be either performed in community medical services or in the hospital [9][10][11]. Such programs generally include administration of therapeutical measures, remote monitoring, periodical clinical follow-up, and nurse-based care [8][9][10].…”

“…These services generally substitute inpatient care after an initial diagnostic evaluation, which can be either performed in community medical services or in the hospital [9][10][11]. Such programs generally include administration of therapeutical measures, remote monitoring, periodical clinical follow-up, and nurse-based care [8][9][10]. Comprehensive geriatric assessment (CGA) is usually a cornerstone of hospital-at-home services tailored to older people.…”