Hospital at Home

There is a need to improve Patient Care with an emphasis on keeping patients, and potential patients at home in their own environments.

NHS England support for Virtual Wards:

We know that patients who are supported through an acute illness are able to recover better in their own homes, with less chance of deconditioning and more chance of staying connected to their carers and communities, and have better outcomes and less reliance on long-term care options

including Urgent Care response and Local Virtual Ward

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'Living independently For Everyone'

Central Remote Monitoring Hub

a central Hub for patient contact
reviewing and monitoring data from connected devices
reviewing and monitoring consultations with patients - telephone and videoconferencing
reviewing and monitoring data from other systems
- triggers from algorithms networked with system eg pathology, co-morbidities
- triggers from background monitoring eg Care Homes

Vision for expansion

Pathways
- coordination of investigations and feedback
Team
- need for Task based staff supporting device delivery and fitting
- need for more doctors to oversee greater decision making and coordinate investigations
- development and training of medical and nursing staff in a new speciality
- dedicated pharmacy support - abundant errors currently
Greater device integration - eg live ECG, owner's kit

need for single platform which links Care Groups of all types - eg. GP, Care Homes, Acute Trusts
Central Intelligence Team - monitoring and preempting deterioration
greater development of POC investigations
networking Primary Care, Intermediate Care (Care Homes of all sorts) with Acute Trust teams to provide remote reviews - enhanced telehealth vs in person reviews.

Barriers

Risk averse behaviour:

over referral to other clinicians
- GP's to ED and specialists
- Hospital Consultants to other Consultants

Lack of confidence in platforms

Opportunities

Point of Care Testing

expensive
quick turnaround with results while Clinician at patient's home
wide range of Investigations - most of what is commonly ordered

Pathways

Cardiac
- Heart Failure
- arrhythmia management
Respiratory
- asthma
- IECOPD (infective exacerbation of COPD)
- CAP (Community acquired pneumonia)
Gastro-Intestinal
- Diverticulitis
- Cholecystitis
Palliative Care

Care Homes

Learning disability
Nursing Homes

Strategy

Communication

Communicating and involvement requires frequent messaging but should be built into the fabric of the culture of the Trust. Informing patients of choice and stimulating involvement while also providing a constant reminder to staff of the 'ideal' disposition.
information boards have been used in Emergency Departments in particular to enable patients to understand expectations