Hospital at home

The Scottish Government’s 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home. Hospital at home has been an approach developed to deliver interventions, traditionally carried out within a hospital setting at home. The following describes the service offered in West Lothian CHCP, part of NHS Lothian.

What does REACT offer

The Rapid Elderly Assessment Care Team (REACT) was established in May 2013 to offer this ‘hospital at home’ service. The team includes medics, community nurse practitioners, pharmacy and allied health professionals offering rapid access to comprehensive assessment within a homely setting.  Referrals can be accepted from the community or as part of our supported discharge pathway. For example, community nurse practitioners have extended clinical examination skills and are able to provide interventions such as IV antibiotics in patients own homes. REACT also offers rapid access to AHP support and rehabilitation, critical to the testing and development of our supported discharge work shortening length of stay within hospital.

REACT receive around 60 referrals a month with a typical response time from referral to first contact of between 1-2 hours. REACT interventions typically last for around 5 days within a service users own home.

What do the numbers say

Since its inception the REACT hospital at home have received over 1000 referrals culminating in over 7000 care days for service users who would have otherwise been admitted to hospital. This outstanding work was recognised by NHS Lothian when REACT was awarded the accolade of NHS Lothian team of the year 2014.

What do our service users say

Service users and their families are our most valuable assets. Patient and carer organisations have worked with the team to help shape the care that we offer and ensure that patient/carer voices who have used the service are central to REACT development. John described his care as ‘second to none’, “I felt totally supported by the care I received from REACT”. Margaret told us that being able to get the care she needed in her own home had “definitely helped in her recovery”.  Donald’s family said “without REACT he would not have been able to stay at home and have his family with him right to the end, this is a wonderful service”

Integrate working

Critical to REACT’s success has been partnership working across health and social care. REACT and the social care reablement team deliver rehabilitation and care collaboratively. Client focused goal setting tools and training were developed producing a single documentation system, across health and social care,  held in the service users own home. Plain language goal setting ensures all those involved including family understand their roles within the rehabilitation and recovery process.

Evidence

REACT are working with health economists from the Scottish Government to understand the cost benefits of hospital care at home and participating in a multi-centre randomised controlled clinical trial, comparing typical hospital care with hospital at home.