A new tool to measure acuity in the community: a case study.

The provision of acute healthcare within patients own home (i.e. hospital in the home) is an important method of providing individualised patient-centred care that reduces the need for acute hospital admissions and enables early hospital discharge for appropriate patient groups. The Hospital in the Home (HitH) model of care ensures that this approach maximises patient safety and limits potential risk for patients. As HitH services have seen record numbers of patient referrals in the past 2 years, there is now a greater need to measure and understand the acuity and dependency levels of the caseload. Through an expert clinician development process at one NHS trust, aspects of procedural complexity, interdisciplinary working, risk stratification and comorbidities were used to quantify acuity and dependency. This paper uses a case study approach to present a new method of measuring this important concept.

Patient satisfaction with a hospital-in-the-home service.

The hospital-in-the-home (HitH) model is an alternative model of healthcare that allows patients to return home and receive short-term treatment in a familiar environment. The objective of the present study was to evaluate patient satisfaction with the GSTT@home service in the London boroughs of Southwark and Lambeth. A questionnaire comprising 20 questions was developed with 5-point Likert response and free text options. A total of 1426 questionnaires were distributed, of which 206 (14%) were returned. The majority of respondents said they would recommend the @home service (n=200, 97%) and were very satisfied or satisfied with the service (n=203, 99%). Only 48 respondents provided qualitative free text comments, and overall, these were very positive and supportive of the @home service. The findings support the benefits of the @home model of care from the patients' perspective.

The future of community nursing: Hospital in the Home.

With an increasing ageing population who often have multiple long-term conditions, there is a growing need to provide an alternative type of care to the traditional hospital-based model. 'Hospital in the Home' is a model that provides integrated care for patients in their home. The @home service was established in 2013 by Guy's and St Thomas' NHS Foundation Trust. The service provides health care in patients' home, supporting early discharge from hospital as well as preventing avoidable admissions and readmissions saving valuable hospital bed days and reducing length of stay. This article describes the service available with the use of a case study of a 78-year-old lady who was referred by the London Ambulance Service with exacerbation of chronic obstructive pulmonary disease (COPD). This case study highlights the ability to assess, treat and manage an acutely unwell patient with newly diagnosed heart failure in the community without the need for hospitalisation. This type of integrated care model with a multidisciplinary team is a feasible alternative to the traditional models of care in both the acute and community settings.