Aims The 2012 NHS mandate recommended reduction in the length of stay for inpatients, to improve the care of patients with both long term conditions and those with acute problems. Reference was also made to improving patients’ experience of care.
In paediatrics, these visions are most easily realised within ambulatory paediatrics. In April 2014 a pioneering ambulatory care service was established at our hospital, with ‘Healthcare at Home’ (HAH). The first childrens’ service of its kind, it is a consultant led, nurse delivered model of acute paediatric care. The nurses visit children up to four times a day, to administer medication, perform observations and provide clinical review. The observations and notes are recorded electronically. A daily consultant-led virtual ward round is conducted with the HAH nurses, facilitated by review of the patient’s electronic health records. The initial goal was to enable early discharge from hospital, with future aspirations to facilitate admission avoidance with direct admission to HAH from the paediatric emergency department.
Methods Activity data for the first 9 months has been analysed and patient experience feedback has been evaluated.
Results 78 patients have been accepted onto the HAH service to date, giving 815 visits, and saving 389 bed days. 796/815 (97.7%) were for administration of IV medication, with 48% for medications needing to be administered more than once a day. Referrals are increasing, with the majority from the general paediatrics service (90.5%). Orthopaedics, gastroenterology and neurosurgery contribute the remainder. There have been 28 episodes of patients re-attending following transfer to HAH; 22/28 (78.6%) have been due to problems with intravenous access, and 6/28 (21.4%) for clinical review. No patients have required readmission to the hospital. Patient feedback has been excellent with 100% of questionnaire responders saying they would recommend HAH to their friends and relatives.
Conclusion HAH is in its infancy but, thus far, has delivered exemplary clinical care. As stated in the NHS mandate, improving the experience of patients’ and their families is essential The development of a flexible and robust community nursing service, which provides excellent acute clinical care is a proven means of facilitating this.
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