2. Hospital at Home Dr Catherine Monaghan Belinda Peckett Amy Wynne
Trust Member Event
Wednesday 21 June 2017
Hospital at Home Dr Catherine Monaghan Belinda Peckett Amy Wynne

3. Hospital at Home Background to the service Patient journeys
Key Performance Indicators
Added value
Where next
Patient experience

4. Hospital at Home MDT delivered, consultant led service
Delivers care at home for patients with exacerbations of COPD across the CCG
Provides a full package of care tailored to an individuals’ needs
Offers both early supported discharge and admission avoidance

5. Background
Hospital Admissions for Exacerbations of COPD (Per 1,000 COPD Registers): 146.9
Mean Length of Stay in Hospital for COPD interventions: 5.94 days
Cost of Hospital Interventions for Exacerbations COPD (£ Per 1,000 COPD Registers) : £ 298,164
approx. £2.2M spend per year

6. Background Hospital Readmissions within 30 Days: 20.6%
Emergency admissions are increasing year on year:
780 in 2005/6
1,000 in 2012/13
1151 in 2015/16
*Data collected from NEPHO 2013

7. During an acute admission
Patients do not necessarily see a COPD specialist
There is evidence of deconditioning and loss of muscle mass
Admissions are not necessarily good for patients
Psychological detriment to patient

8. Hospital admissions with COPD
Why do patients need to be admitted:
If they are seriously unwell and need emergency oxygen or ventilation
Why are patients admitted when they don’t need to be:
Because there is (was) no alternative

9. Offers a serious alternative to an acute admission
Hospital at Home
Offers a serious alternative to an acute admission
Provide acute care at home for patients with exacerbations of COPD
Consists of a multidisciplinary team of experienced health care professionals
doctors, nurses, physiotherapists, HCAs
Service available 8am-8pm 7 days/week
The hospital at home service comprises a team of health professionals who are experienced in caring and treating patients with breathing problems.
The team is comprised of Doctors, nurses, therapists and health care assistants who will provide timely, safe and effective care and treatment to patients with Chronic Obstructive Pulmonary Disease (COPD) within their own home and, or community setting who are experiencing severe breathing difficulties
The purpose of the service is to treat patients with COPD in such a way that they do not need to go into hospital for treatment and / or to help patients to return home more quickly following a stay in hospital following severe breathing difficulties.
Envisaged a 7 day service 8 - 8

10. H@H Referral criteria: Known COPD Increased SOB Increased sputum
Increased cough

11. Exclusion criteria
• Unconfirmed diagnosis of COPD • New Hypoxia with SaO2 <88% on room air • New or worsening oedema • Acute confusion • Impaired level of consciousness • Central Cyanosis • Respiratory rate >24
• Pulse Rate >125bpm • Significant chest pain • Hypotension BP <90/60
• Rigors

12. Referrals Referrals accepted from different health care professionals:GP
Community matrons
Accident and Emergency
NEAS
Acute trust
Rapid response

13. Self referral
Patients can self refer if they have already been through the service

14. How to refer Fax referral to SPA Phone SPA
SPA then task the team directly
Patients can phone the SPA and self refer into the service

15. What the service offers
A home visit within 2 hours of referral being received
Comprehensive assessment by a professional with expertise in COPD
An individual Programme of care tailored to each patients specific need

16. What the service offers
Support and care at home
Medical interventions;
Nebulisers
Antibiotics
Steroids
Chest physiotherapy
Sputum clearance techniques
Symptom management
Inhaler advice and technique
Medicines management

17. Every patient is offered:
A full review of treatment
Advice on smoking cessation
Referral to pulmonary rehabilitation
A written plan as to how to self manage their COPD
A six week consultant follow up review
A phone number to call if they become unwell again
Signposting to other services: D/N, palliative care, Dietician

18. Safety
Access to a respiratory consultant 9am to 5pm Monday to Friday for advice
One hour per day of rapid access slots with a respiratory consultant
A weekly MDT
A six week follow up appointment

19. Patient Journeys
Dorothy T

20. Dorothea W

21. Gloria

22. What our patients receive
Comprehensive assessment from respiratory practitioners with advanced respiratory skills.
Treatment prescribed and issued in accordance with patients symptoms and clinical findings.
Weekly discussion at MDT

23. On going management and support from the team with no time limits, based on clinical need.
Multidisciplinary working, working along side other health professionals to make every contact count including close links with NEAS
High standard care delivered with compassion

24. Open and honest communication with our patients around disease management and disease progression.
Health education and promotion.

25. Pre service criticisms and our experience so far
“patients won’t like this, they want to be in hospital”
“this is potentially unsafe, what if a patient is really unwell”
“what if the diagnosis isn’t COPD?”
“you will get a lot of referrals for patients that don’t need to be in hospital”
“GPs won’t use this: its easier just to admit a patient”

26. Key Performance Indicators
Referrals received: 1684
New patients seen: 1535
Home visits: 5210
Inappropriate referrals: 120
Acute admissions: 60

27. Other data Mean length of stay has reduced by 17%
Admission avoidance is difficult to measure exactly:
we think about 60% of the patients referred into our service would otherwise have been admitted
this leads to a 33% reduction in the number of admissions we would have expected

28. PDSA
PDSA in November 2016
Between 8am-8pm every GP who wanted to admit a patient with COPD was asked if they wanted to refer them to the team instead
We admitted zero patients with COPD that week from GPs

29. Referrals into service

30. Added value Ensuring diagnosis is correct Optimize medical treatment
Medication to reduce risk of future exacerbations
Optimize inhaler treatment
Making sure patients are on the best and most cost effective inhalers
Signposting to appropriate services

31. Patient experience
Patient survey

32. Patient experience Always helpful and never rush
Could not ask for better treatment
100% better than being admitted to hospital
I have never known care like it
Best service I have ever come across
We need this team: I will never be afraid if I’m poorly

33. Summary
Refer all patients with an exacerbation of COPD who meet the criteria
Send referral via the SPA
Team will visit within 2 hours: 8am-8pm 7 days a week
We will provide a full programme of care

34. Patient experience Patient experience Video
Very powerful for campaign care closer to home for NHS England.

35. Where next? Further work with NEAS
Strengthening links with GP practices
Doing practice visits and case reviews, at request of CCG
Expand the number of conditions we cover
bronchiectasis

36. Where else can we use this model?
Frail elderly
Nursing and care homes
Heart failure

37. Thank you