NHS England » Case study: urgent community response, virtual ward and care home teams work together to enable people to stay at home

Summary

In Cheshire West, the Hospital at Home team provide an integrated urgent community response service (UCR) and a frailty virtual ward for people living in care homes. When a resident requires urgent care they get fast access to a range of health and social care professionals within 2 hours through the UCR team. If they require ongoing monitoring and/or further treatment, they receive care through the frailty virtual ward.

Prior to the start of the project in May 2022, the number of referrals into Hospital at Home from care homes was minimal (2-3%). There were a high number of residents attending emergency departments and being admitted to hospital when they were unwell.

As a result of this service, there has been a significant reduction in emergency department attendances and hospital admissions. Resident’s quality of life and overall wellbeing improved as they were able to be cared for in their home.

How does this service work?

The Hospital at Home team have been working closely with GP practices, ambulance services to support 4 care homes that had the highest number of people taken to the emergency department when residents became acutely unwell. The team introduced a clinical decision-making tool to help care home professionals understand which health services might be most suitable for the people in their care. Through this tool, care home colleagues improved their knowledge about when Hospital at Home might be an option for a resident.

The Hospital at Home team, when delivering the UCR service, will always visit patients face to face. For those who require ongoing monitoring and treatment, then they are onboarded onto the frailty virtual ward, where in appropriate cases they receive daily face to face visits and sometimes medical interventions that would otherwise be provided in hospital, such as IV antibiotics and fluids.

Example of a referral into the urgent community response service:

A care home resident living with dementia, became more confused and very sleepy. They had presented with chest and urinary symptoms. The Hospital at Home team stepped in, completed a holistic assessment, including taking blood samples. The resident was diagnosed with chest infection and started on board spectrum oral antibiotics. The resident was also found to have developed an acute kidney injury (AKI) stage 1 and with the support from care home colleagues, he was started on IV Fluids for 2 days. Following this intervention, the resident made a full recovery. The ED attendance was avoided which would have otherwise worsened his dementia symptoms.

What impact has this service had?

This pilot was so successful that this way of working was expanded to support 32 care homes and 154 people living in West Cheshire care homes, by October 2022. This partnership work had a significant impact in the reduction of ED attendances from care home residents and improved the persons’ clinical and wellbeing outcomes. There has been a considerable increase in the number of referrals directly from care homes into the Hospital at Home Service with a total of 154 residents referred onto the service between May and October 22, with 94% of referred people living in care homes supported to remain in their homes as of October 2022.

How have you found working on this?

“The service is absolutely brilliant. As an experienced qualified clinical nurse and now the clinical lead of Iddenshall Hall/Beeston View I can attest to the advantages having this service has. As of May 2022, 75% of our residents live with dementia so not only have the residents had the benefit of being treated within their own home but the treatment has been followed up by the team. We cannot rate the service provided high enough and we are extremely grateful to the team.”

Andrea Lawrence, Deputy Manager/ Clinical Lead Nurse at Iddenshall Hall & Beeston View

What would your top tips be?

Direct engagement with care home colleagues to build the professional relationships.
Promotion of the UCR /Hospital at Home service with GPs to allow for a greater understanding of what is available so that the service is a consideration first before deciding to call for an ambulance.
Providing phone advice from the UCR /Hospital at Homes service to give care home colleagues the confidence to manage the persons’ healthcare needs with clear safety netting in place, as an alternative to calling for an ambulance.

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