Integrated community Assessment and Support Services (ICASS) Hospital at home

ICASS is a service which aim to deliver care, support and rehabilitation to patients in their own home or care homes .The service is made up of three main parts which work closely together: Hospital at home ; Intermediate Care Team; Homecare Re-ablement .

Scottish government established a change in fund of 70mil£ for 2011/2012 to enable health and social care partners to implement local plans for making better use of the combined resources for older people services . The aim of this programme is to shift the balance from admissions to hospital settings to community settings, to support early discharges from hospital and promote patients independence within own environment.

Fife has been successful in secure 4,9 mil to support local development and implementation of reshaping care for older people . Present way of dealing and treating elderly patient is unsustainable and required new alternatives to hospital admissions. Guided by the welsh model from Torphecan redesigned and adapted to suit Scotland ‘s health challenges regarding elderly population, ICASS had been initiated .

Service development The programme is piloted in Dunfermline and West Fife CHP and had started on April this year .The programme will be extended to Fife other 2 main regions: 1) Glenrothes and North Fife CHP ; 2) Kirkaldy and Levenmouth CHP area which will be starting in October this year.

How does it work It is an alternative to hospital admission for appropriate patients. Hospital at home is for patients who are suitable and safe to be cared of and treated at home also for those with chronic long term conditions.

Other group of patients admitted to Hospital at home are patients discharged from acute settings continuing the treatment in their own environment . The service is designed for population over 75 years old, but this range age group is flexible to other age groups below 75 years if appropriate .

Dunfermline and west fife service The hospital is led by an Consultant Geriatrician The medical team is formed by 2 GPs; Nursing team – is formed by highly trained nurse practioners ; trained nurses and health care support workers who have enhanced clinical skills. The nursing team work together with physiotherapists and occupational therapist,dieteticians ,podiatrist ,social workers who are part of ICASS service

Hospital at home receives the biggest percentage of referrals from GPs from Dunfermline and surrounding areas; Referrals from hospital for patients who are fit for early discharge continuing treatment at home; Referrals from AMAU (Acute medical admission unit) . Hospital at home is open 7 days /week from 8 am until 10 pm .

Assessment Following a referral patient is assessed at home by GP or nurse practitioner or both. Assessment involves: General examination ; Observations ,blood tests , urine analysis ; ECG, arrangements for X-ray ; Comprehensive geriatric assessment . Social and home environmental assessment.

Once assessment is completed ,the team co-ordinates a management plan and address other social or nursing needs that patient requieres.This might include: Referrals to social work for social care imput; Attending consultant out patients as a part of treatment or day hospital for follow up; Following the assessment if patients are not suitable to be treated at home ,will be admitted to hospital

Patient management plan includes depending of diagnosis : oral medicine administration , iv hydration ; s/c fluids administration ; iv drugs /antibiotics administration ; home O2 therapy ;

urinary catheterisation male /female /suprapubic; wound management ; palliative care ; Patients length of time of admission is maximum 2 weeks or less depending of diagnosis and treatment .

Hospital at home statistics from April 2012-august 2012 RESPIRATORY INFECTIONS /EXACERBATION COPD 14 UTI/HAEMATURIA 4 CELLULITIS 6 FALLS /REDUCED MOBILITY 5 DEHYDRATION ADMISIONS TO HOSPITAL 7 REFERALS NOT ACCEPTED 15 OTHERS (HICKMAN LINE CARE ,PAIN MANAGEMENT ,DIABETES COMPLICATIONS) 16 TOTAL 73