At Dorset County Hospital we have developed an Acute Hospital at Home (AH@H) service, providing a number of aspects of inpatient care in people's own homes, delivered by a full multi-disciplinary team.We have developed a clear pathway for management of patients with infective exacerbations of bronchiectasis, who require intravenous antibiotics at home (usually for between 10 and 14 days).
These patients receive clinical care guided by our Respiratory Physicians, having intravenous antibiotics, nursing care - including clinical observations, blood tests, and also chest physiotherapy at home.
The MDT managing the patients includes a medical Consultant, nurses, occupational and physiotherapists, a pharmacist, dieticians and speech and language therapists.
We undertook a study (published as an abstract by the British Thoracic Society) comparing the care for patients who were previously admitted to hospital for their treatment with those now treated through the Acute Hospital at Home service.
The link to the press release from the British Thoracic Society is below https://www.brit-thoracic.org.uk/pressmedia/2017/acute-hospital-at-home-scheme/
Our study showed equivalence in terms of clinical outcomes for these patients, with a significantly reduced inpatient length-of-stay (2.5 days compared with 9.1); improved patient and carer feedback; and a cost-saving of £1 140 per patient, per admission.
We feel that there are significant benefits to managing these patients in their own homes, including being with family and friends, eating meals at one's preferred times, sleeping in one's own bed, and a reduced risk of hospital acquired infection and deconditioning.
We believe that our model could be replicated across the country, improving care, freeing up hospital beds, and providing a financially viable model for the future.