1. Adult Hospital at Home Service Sue Gibbs 27 th March 2014

2. 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

3. The Patient Story who 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

4. Increased confidence in ability to manage own condition Value Added Benefits Some 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

5. Service hours  7 days  8am – 8pm Run by  Registered Nurses  Therapist  Pharmacist  Administrator Description of the service

6. 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.

7. 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

8. Ambulatory Care and Virtual Ward

9. Ambulatory Emergency Care Service 9 9

10. 10 The clinical model Consultant-led service Integrated between Acute Medics & ED Surgical 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

11. 11 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.

12. 12 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

13. 13 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 COPD Cellulitis Surgical abdominal pain HIV Jaundice Pleural Effusion Renal Colic A few examples of conditions…

14. 14 Number of attendances Since the service launched in February 2012, there has been a marked increase in the number of attendances to Ambulatory Care. 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

15. 15 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.

16. 16 Whittington Health Magdala Avenue London N19 5NF Tel:020 72883070 Fax:020 7288 5550 Website:www.whittington.nhs.uk