Keeping patients out of hospital this winter

15 January 2024

Southern Health NHS Foundation Trust is working hard to keep patients out of hospital by providing clinical support to them in their own homes.falls and frailty car_with male patient.jpg

Referred to as virtual wards or Hospital at Home, and part of the urgent community response service the Trust offers, the aim is to provide acute level care in a community setting avoiding the need for admission, or in some cases readmission to hospital. The “wards” are led by consultant practitioners, and have a range of clinicians, including advanced clinical practitioners, occupational therapists, paramedics, nurses, and physiotherapists, who can visit patients in their own homes, assess, diagnose, treat, and monitor.

In November, 93% (1,672) of patients seen across Hampshire avoided admission to local hospitals and were able to be cared for in their homes. Over the last year 90% of patients seen have avoided hospital admission within the seven days of being seen. 

Phil Evans, a Consultant Practitioner for Frailty and joint-lead for virtual wards in South West Hampshire for Southern Health NHS Foundation Trust, says: “We bring the hospital to the home and deliver acute care to community-based patients. If you are unwell, we are able to assess, test, diagnose and treat at home avoiding the need to be admitted to hospital. We primarily work with older adults with acute deteriorations and can access many hospital investigations in the community.”

Phil says they can leave monitoring devices with the patient so they can remotely monitor them. He adds: “We are also able to undertake “by the bedside” blood tests with the results available in minutes rather than days. Excitingly we will soon start using portable ultrasound to further increase our effectiveness at diagnosing and treating our patients in their homes.”

The service has received excellent feedback via CareOpinion, including an elderly gentlemen in his 90s received care from the team, after taking a fall at home and not wanting to go to hospital.  The frailty team contacted his family, were able to visit the same day, and take observations including blood tests, made recommendations for treatment and adjustments to his home to avoid future falls. Having the team visit certainly kept him out of hospital. His son commented: “We have been so impressed with the frailty team including the consultant practitioner who also visited on one occasion. Before this last fall we did not know about the team and now do know how to contact them again via his own doctor. For us the family and especially my Dad this was an amazing service funded by the NHS.”

Referrals for this service come from GPs, ambulances and those discharged from hospitals, including Southampton, Lymington, Salisbury, and Bournemouth, as well as other specialists working in healthcare like physiotherapists who can raise concerns about their patient’s welfare.  This service is not only enabling patients to stay at home but is also having an impact on minimising pressure on the emergency services and hospitals.

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