Clinicians in Kent are supporting people living with frailty in their own home, through a frailty Hospital at Home virtual ward.

Summary

Our frailty Hospital at Home virtual ward was set up in response to COVID-19, to help people living with frailty avoid going to hospital.

The ward is run by Kent Community Health NHS Foundation Trust (KCHFT) Community Frailty Team, in an area with a population of 500,000, which includes 275 care homes and more than 6,000 care home residents.

As a coastal area which has traditionally attracted retirees, we provide services in locations with a higher frailty need than much of the UK.

How does the frailty Hospital at Home virtual ward help people?

We are a team of consultant geriatricians, doctors and advanced clinical practitioners, who accept referrals from paramedics, GPs, care homes, acute trusts, and community hospitals and teams. We provide an alternative to hospital care in the person’s home and in care homes.

Our motto is: “We find out what you would want, and we try to provide it”.

Recently we supported a patient in his mid-80s who had been discharged from hospital the week before. He had been feeling unwell and a blood test showed severe kidney problems. He didn’t want to go to hospital if it could be avoided.

We assessed him at home and took further blood tests using point-of-care testing. We adjusted his medication and worked with our urgent community response team to provide equipment and personal care. We reviewed him daily either virtually or personally.

He was discharged from our care a week later feeling much better and his kidney function had returned to normal. He was very pleased he hadn’t needed to go to hospital.

A relative of the patient said: “We were over the moon when we realised we could have treatment at home rather than going to hospital. The service the team provided was second to none and he was so much better when he was discharged”.

We’ve found that benefits to the patient include:

• the option of hospital-level care provided in their own home, which patients like
• they can be closer to family support networks, which can help their recovery

Feedback has been hugely positive.

What’s it like working on a virtual ward?

We start our day with a virtual board round and then go out on face-to-face visits, whether to new assessments or reviews. Most contacts are face-to-face, but we do some virtual assessments using video.

Team members agree it is rewarding to be part of a dynamic programme. There is a shared culture of learning, always keeping patients’ wishes at the heart of the care we deliver and seeking ideas on how we could further develop our service.

As one trainee said: “It’s a truly amazing feeling, when we treat someone with delirium at home with IV fluids and they improve within the hour, being back to themselves.”

“Patients are so thankful to us for being able to stay in their own homes. It means the world to them”.

Key outcomes

By October 2021:

• We saw 3,721 patients
• We had 200 referrals on average each month
• We helped 90% of patients stay at home
• 45% of our assessments were virtual (higher during COVID peaks)
• 7% of our patients were readmitted to our virtual ward.

Our top tips for setting up a virtual ward:

• You can undertake a good virtual assessment of the patient in their own home, often supported by the paramedic team or a patient’s family
• A daily morning multidisciplinary team meeting is vital to make sure the team know what’s going on and learn from each other
• We all had to learn new skills
• Don’t just buy point-of-care testing equipment without spending time learning the quality control and protocols
• Virtual assessments using video technology work well for frailty assessments and reviews
• Make sure you have a really good way to run a caseload
• Pharmacy support is essential
• Hold a steady nerve, especially if you are doing what the person wants

Authors:

Sharel Cole, Advanced Clinical Practitioner, Frailty Team, Kent Community Health NHS Foundation Trust

Shelley Sage, Consultant Practitioner for Frailty, Kent Community Health NHS Foundation Trust

Dr Shelagh O’Riordan, Consultant Community Geriatrician, Kent Community Health NHS Foundation Trust