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‘Acute hospital at home’ scheme improves care for lung disease

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An innovative scheme that sees nurses visit patients where they live improves care for people with lung disease, frees up hospital beds and saves health service resources, according to researchers.

They said the scheme, where hospital patients with lung disease are treated at home, is effective, saves the NHS £1,140 per case, and has extremely high patient satisfaction ratings.

“We have been able to free up much needed hospital beds whilst improving care”

Jennifer Graves

The researchers believe that if the scheme was more widely adopted across the country it could improve care and has the potential to save the NHS millions of pounds.

Their findings on the “acute hospital at home” were presented today at the British Thoracic Society’s 2017 Winter Meeting in London.

They noted that at a national level over 12,000 people were admitted to hospital in England during 2013-14 with bronchiectasis, which affects around one in 1,000 adults in the UK.

Bronchiectasis occurs when the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.

Clinicians at Dorset County Hospital NHS Foundation Trust concluded that most admissions needed two weeks intravenous antibiotics to eradicate infection, but did not need to be in hospital.

From January 2016, an acute hospital at home (AHAH) team was developed to specifically treat bronchiectasis patients at home, where appropriate. The multi-disciplinary team includes medical consultants, microbiologists, nurses and physiotherapists.

In addition to daily home visits by the team administering medication, a consultant regularly reviews the digital notes on each patient in a “virtual ward round” and will visit the patient as required.

The research included retrospective analysis of 51 patient records to review clinical outcomes including length of hospital stay, infection rates, culture rates and cost implications.

The study findings not only revealed a substantial financial benefit but also significantly improved patient satisfaction. It found 98% would recommend the service to family and friends, compared to 83% managed on an inpatient ward, as they could enjoy their home comforts and could even continue to work.

“Our study has revealed a whole range of benefits of treating this group of lung disease patients in the community”

Jennifer Graves

The research also showed that, following the start of the new service, hospital stays reduced from an average of 9.1 days to 2.5 days, meaning a reduced risk of possible hospital-acquired infection.

In addition, the scheme was just as effective as purely hospital-based treatment when measured by the number of patients being readmitted to hospital in the future, said the researchers.

Dr Jennifer Graves, a respiratory consultant at Dorset County Hospital, said: “Our study has revealed a whole range of benefits of treating this group of lung disease patients in the community.

She said: “By ensuring consultant-level involvement and careful daily monitoring by a highly skilled NHS team, we have been able to free up much needed hospital beds whilst improving care.”

“Bronchiectasis patients are prone to recurrent infections and so have previously faced a number of two week stays in hospital throughout a year, purely to receive intravenous medication,” she said. “Now we can completely treat them at home, or in extreme cases treat them in hospital for the first 48 hours and then let them continue treatment at home once that’s appropriate.

“We believe this far more personal care is forward-thinking for a hospital of our size, and is in line with national guidance,” said Dr Graves.

She added: “It is saving budgets as well as allowing patients to be more active, which aids recovery by helping to keep the chest clear of phlegm, and to avoid infection from other patients.” 

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