Dr Claire Steel ended up in Hospital At Home by accident. A snowboarding accident to be precise. But she quickly became a convert to the benefits it brings to patients. As our organisation’s ihub works with NHS boards across Scotland to establish more Hospital At Home services, Claire explains why every NHS board should introduce Hospital At Home as part of the service they provide to people requiring acute care.
In a way, it was becoming a patient myself that made me a convert to Hospital At Home. When I was due to take on my first consultant role, I broke my wrist snowboarding and couldn’t go onto a ward until I was healed. Instead I spent time in the community with a Hospital At Home service. Hospital At Home delivers acute care to people in their own homes through the co-ordinated efforts of a specialist team working together to keep the patient out of hospital, at the same time improving their health. I found it so inspiring that when a consultant position came up with NHS Lanarkshire, I was keen to apply as I knew they had a Hospital At Home service.
As Healthcare Improvement Scotland works with other NHS boards to help establish similar Hospital At Home services across Scotland, I’m reminded of the many reasons to love working in a Hospital At Home service and being out in the community, delivering care to patients in their homes. It might seem like a lonely business driving from one patient to another, but that’s far from being the case. It’s a day filled with discussions and conversations with other professionals, patients and family members. You still spend a lot of time on the phone discussing patients and making arrangements. Every morning we have a ward round with nursing staff before going out to undertake our visits. On home visits, usually another clinical member of staff will be there with me. The teamwork is great. It feels a lot less hierarchical – everyone is on the same level carrying out their individual duties.
In hospital, if I’m trying to get the history of a patient, it’s a matter of asking many questions and then using my imagination to try and piece together what their life at home looks like. With Hospital At Home, it’s all there. If I’m trying to get a history of a patient, Hospital At Home gives me a vivid picture before my very eyes. I get an immediate sense of what the patient’s situation is like, the care arrangements and what is required for them. Each patient’s home tells a different story and this story can be vital in helping me and the team to give the patient the care and support they need.
When is a hospital a Hospital At Home?
A typical Hospital At Home has three components: the severity of the condition that’s treated has to be similar to the type of condition they would be admitted to hospital with, the service must have access to diagnosis (for example, being able to get test results, X-rays or scans as promptly as would be the case in hospital), and care must be led by a consultant.
The Lanarkshire team works out of a space within University Hospital Monklands (one of three hubs in Lanarkshire). I work from there, but the services at Hairmyres and Wishaw have all our medications and equipment. Each member of the team acts as if each patient is right there in front of them in a hospital bed. The nurse will have phoned on ahead to see how the patient is and we discuss their condition; there may be bloods or reviews; we decide on treatment or an investigation plan. It just so happens that the patient requiring acute care is still in their home.
Our service in Lanarkshire was set up for over 65s – other parts of the world that provide Hospital At Home can provide care from mid-teens onwards. The main conditions that we treat are delirium, infections of all kinds, wounds, dehydration, kidney injuries, falls, heart failure, CPD (COPD), and palliative care.
In terms of equipment, we can provide support that a GP would not be in a position to provide. For example, we can provide drips for dehydrated patients, heart traces, intravenous antibiotics, nebulisers and oxygen. We also help provide advice to GPs, which can be helpful when a patient needs a quick diagnosis as we can get test results back more quickly.
The benefits to patients
There is, of course, still an important place for hospitals, especially in the care of older people. We admit patients when they can’t be looked after at home and when patients themselves are not comfortable being treated at home, or able to get the care and support that they need. But the real benefits to patients of care at home are many. We’ve seen during COVID-19 the loneliness of hospitals, especially for older patients, when contact with relatives was not possible.
We know that many older patients worry that if they go into hospital that they won’t come out or will end up in a care home. We know that there’s an increased risk of confusion, especially when patients are moving between different wards, and the risk of falls goes up also. Older patients can become medicalised in hospital and bedbound, where at home they’re more likely to continue their day-to-day routines, getting up and about, which can help them to stay healthy.
The benefits of Hospital At Home are being seen by more and more NHS boards across Scotland. But it’s great to see Healthcare Improvement Scotland providing support to boards so they can understand the benefits of Hospital At Home and work to establish services of their own. Some are gradually growing the service while others are scoping out how they might put it into practice. After 10 years of Hospital At Home in Lanarkshire, we know that this can only be good for patients and families alike.
Dr Claire Steel is a consultant geriatrician working in the Hospital At Home service at University Hospital Monklands in NHS Lanarkshire.