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Hospital at Home Model helps ease COVID-19 pressures


With current pressures on Hospitals and Care Homes being more acutely felt than at any other time in recent memory, the Western Trust has re-emphasised the important role played by the Trust’s “Hospital at Home” service.

The Consultant-led service was launched in January 2021 with the aim of making individual patient’s homes the hub for delivering health and care for our elderly population across the Western Trust area.

The “Hospital at Home” service, which was developed in the middle of the COVID-19 pandemic, has received a high level of support from the public as it seeks to provide an additional strand of support to the Trust’s Hospitals and Care Homes.

The service provides Hospital level care for ill patients who can safely manage in their own homes, whilst keeping them COVID secure and closer to the people they love and within an environment that is familiar to them.

In turn this service keeps additional stresses off Hospital and Care Home facilities during what is an incredibly pressured period as winter approaches.

Since its launch patients have been able to receive treatment and ongoing care in their own homes, removing a great deal of stress and inconvenience, which had been a particular cause of concern for patients during the ongoing COVID-19 pandemic.

The programme has been earmarked as a central element in the future regional model for Intermediate Care as well as the ‘Enhancing Clinical Care into Care Homes’ regional initiative in keeping with local needs, Pathfinder engagement feedback and regional policy.

Speaking about the important role played by the Hospital at Home Programme, Claire Aiken, Western Trust Clinical Lead Nurse with the Hospital at Home Team, said:

“Through the Hospital at Home Programme we provide an alternative to hospital assessment and admission. We strive to give hospital-level care for ill patients who can safely manage in their own homes, whilst keeping them closer to the people they love and within the environment that is familiar to them.

“We have the potential to treat most acute illness in adults over 18 years of age with the exception of heart attack, stroke, trauma, sudden loss of consciousness, acute mental health crisis.”

Hospital at Home operates as a consultant-led team with Dr Mark Roberts leading and is supported by a variety of staff, including, Dr Irfan Khan, who said:

“The Hospital at Home Service is new, having started in December last year. We normally take patients form the GP and Northern Ireland Ambulance Service (NIAS).

“We can manage patients at home where they are stable, like chest infection, UTI, cellulitis, dehydration and heart failure. So we will take patients who are perhaps not keen to go to hospital, or who are quite frail and would prefer to be managed at home. Our staff go to patient’s homes every day and treat them if there is any infection, or if they have dehydration or heart failure.

“We recognise that we have an increasingly elderly population and patients who remain in hospital for what can be extended periods of time than we would like and thus are at increasing risk of hospital acquired infections, loss of their confidence and social connections with their family and local community.

“These concerns are very real and the Western Trust has developed the Hospital at Home programme with this key consideration in mind. Amongst older patients, many of which may feel anxious and distressed being away from their home environment, we often see an increase in stress. Patients too can experience an increase frailty and be at increased risk of delirium and falls.”

Supporting the Team Kay McDonald, Staff Nurse with the Hospital at Home Programme said:

“An example of care which we have recently provided was a lady who was assessed with a shortness of breath.

“On assessment we took clinical observations, bloods and a COVID test, which the Dr used to diagnose her with Community Acquired Pneumonia. Over a seven day period we provided her with IV antibiotics and O2 therapy, to which she responded well and really improved. The patient was very happy with the outcome and in particular that she was able to receive it in the comfort of her own home.”


Explaining the “Hospital at Home” model of care

In November 2020, a Hospital at Home Development Group was formed. With support from the South West Acute Hospital Medical team, Pharmacy and the Rapid Response Nursing team a pilot hospital at home service was established on 14 December 2020.

This initially involved working with four Care Homes in Enniskillen, including, Millcroft Care Home, The County Care Home, Meadow View Care Home and The Graan Abbey Nursing Home.

Through this model of care the team assess and treat residents in these Care Homes to avoid the need to attend Emergency Department and an admission to hospital.

Due to the initial success of the programme it is the intention of the Western Trust’s is to expand the Hospital at Home service, over time to all of Fermanagh and West Tyrone, in keeping with the Pathfinder vision.

The Western Trust will deliver services in line with an Integrated Model for Prevention & Management of Chronic Disease (informed by the King’s Fund model), with greater emphasis to be placed on developing and enhancing Intermediate Care services.

Intermediate Care services will act as the bridge at the transition in a person’s life, in particular from hospital to home and hospital avoidance, from illness or injury to recovery and independence with a strong emphasis on providing personalised health and care to the service user in their own home or usual place of residence.

This is in line with regional strategic direction which is to have effective integrated services organised around the needs of individual people and provided at home, avoiding the need for hospital admission and to support safe discharge from hospital.