NHS Western Isles has this week taken significant steps to further support patients to be cared for in their home environment.

NHS Western Isles is launching a new ‘Hospital at Home’ service, which aims to provide care in the community equivalent to the care provided within hospital. It is used where a patient would normally require admission to hospital but care at home is deemed more medically appropriate.  The service can be used to support discharge from hospital, or to avoid hospital admission, whilst ensuring appropriate and safe patient care.

It will initially be piloted in Lewis and Harris, with plans to expand to Uist and Barra.

Through Hospital at Home, patients will be treated in their own place of residence (their own home, a relative’s home or a care/nursing home) rather than receiving care in hospital. The service will be managed by a dedicated team made up of a wide range of NHS Western Isles clinical staff.

There are many advantages of such an approach which have been demonstrated in various national services of a similar nature. Allowing suitable patients to be cared for in their home environment, with enhanced clinical and nursing support, will avoid the loss of mobility that often occurs with a hospital admission and allow family and other loved ones to be present with the patient during their treatment. This being especially advantageous at a time when hospital visiting has had to be severely restricted due to the risks of COVID 19.

NHS Western Isles Medical Director, Dr Frank McAuley, said: “A high proportion of older people with frailty have been shown to experience a reduction in their functional ability between admission to hospital and discharge, so this is a very beneficial approach for them. It will both prevent unnecessary hospital admissions and also help facilitate appropriate and timely discharge from hospital and avoid people having to remain in hospital unnecessarily.”

The decision on a patient’s suitability for the Hospital at Home service will be made by a Medical Consultant when a patient attends either the Emergency Department, or a Medical or Respiratory Assessment Unit; or during a patient’s stay in hospital. The range of conditions that could be managed through Hospital at Home is not prescriptive, and includes a wide range of conditions such as infections needing intravenous antibiotics, respiratory patients needing short term oxygen therapy and those requiring intravenous fluids for dehydration.

Patients will remain under the care of the hospital consultant and will be monitored on a ‘virtual ward’ within the hospital’s electronic systems.

Debra Vickers NHS Western Isles Cardiology Nurse Consultant, who along with Jane Gillion, Diabetes Lead Nurse, is leading the Hospital at Home service, said: “We are pleased to be very working closely with a wide variety of hospital and community based colleagues to develop this new service, which aims to be of benefit to our patients and their families by reducing in-hospital stays in a safe and effective manner.”

NHS Western Isles is also this week launching ‘Hot Clinics’, an initiative covering the whole of the Western Isles.

Primary Care Clinicians (GPs) now have access to a virtual Hot Clinic which allows them to get Consultant level advice on patients to support their continued care within a community setting, where safe and appropriate. GPs can send an e-mail equivalent referral into Western Isles Hospital in Stornoway. These referrals will be collated every morning (Monday to Friday) to allow the consultant of the day to review them, and provide any appropriate advice and support to the GP. A same day response will mean that appropriate investigations and treatment can be quickly commenced.

Dr McAuley commented: “The hope is that the Hot Clinics will help support primary care clinicians who are caring for vulnerable patients who may be heading towards a hospital admission and give advice to prevent this, if possible. It will also help identify patients who maybe need their hospital admission expedited.”

Commenting on the new initiatives, Dr McAuley added: “I am delighted to see these initiatives come to fruition at a time when care in the community is more important than ever with the COVID crisis. Our aim is to provide excellent care in the most homely setting possible to ensure patients can continue to be supported by family members and maintain as much independence as possible.”