Hospital at Home service launches at Royal Surrey to allow patients to receive hospital-level care in their own homes
A home-based acute hospital service has launched at Royal Surrey NHS Foundation Trust, following a successful pilot. The Hospital at Home ward supports patients living with frailty, who would otherwise be in hospital, to receive the acute care and treatment they need in their own home.
Frailty is a complex condition that affects millions of people worldwide, often leading to potentially avoidable hospital admissions. Once in hospital, patients can spend large amounts of time in bed which can quickly cause muscle wastage and lead to deteriorating health.
By bringing acute care into the patient’s home – including care homes – Hospital at Home addresses the unique needs of patients living with frailty by providing personalised care that focuses on maintaining independence, improving quality of life and preventing unnecessary health deterioration.
James Adams, Royal Surrey Consultant Geriatrician, said:
“Hospital isn’t always the best environment for patients living with frailty. In many cases, home is a safer, healthier environment and it’s usually where they would prefer to stay. NHS research has shown that patients are eight times less likely to experience functional decline and five times less likely to acquire an infection when treated at home compared to a ward in the hospital. This leads to improved outcomes for patients at less cost to the health and care system.”
Patients on the Hospital at Home ward receive care from an integrated multidisciplinary team working across the acute hospital and community services. This includes nurses, doctors, a consultant geriatrician, trainee advanced clinical practitioners, pharmacists and allied healthcare professionals working in partnership with community nursing, the patient's GP, family and carers. Their care includes at least one in-person visit each day from a member of their core medical team and catch ups as needed.
Patients are admitted on a case-by-case basis. They are only admitted where both the geriatrician and the patient or, where relevant, their carer agree that acute hospital care in the home is the best course of treatment. James Adams said:
“It is important to emphasise that this is not a one-size fits all solution. Cases will be individually assessed before admission and joining the virtual ward is a choice made with the clinician, patient and, where relevant, their carer. Since the pilot phase the team has been blown away by the positive feedback received from patients and their families and carers.”
As well as patients benefitting from receiving care at home, the service also helps to free up beds in the hospital for patients who do need to be treated in a hospital setting. Angela Davies, Associate Director of Operations for Integrated Community Services, said:
“It’s no secret that NHS wards, and particularly Emergency Departments, were extremely stretched last winter. For hospitals to keep patients moving out of the Emergency Department, there need to be beds on the wards for patients to be admitted to.
“The Hospital at Home service prevents avoidable admissions into the hospital and supports early discharge out of hospital, helping to free up much-needed beds on the wards for those patients who do need to be in the hospital to receive their treatment.”
A 10-day trial of seven patients on the Hospital at Home ward for an average of 2.28 days showed that this freed up 16 hospital-based beds for patients who needed to be in hospital, helping the Trust treat a greater number of patients in total.
The initiative, which was first successfully piloted by the Trust in December 2022, has now cared for more than 100 patients. By the end of 2023, the Trust has plans to care for 30 patients at any one time on the home-based ward and a number of clinical roles are currently being advertised to support this expansion, with more roles set to be advertised soon.
Hospital at Home is just one way Royal Surrey’s frailty service is revising services to provide the right care, in the right place, at the right time for patients. It follows the launch of a same-day emergency care service last year, where patients are rapidly assessed, diagnosed and treated without being admitted to a ward, and if clinically safe to do so, will go home the same day their care is provided.