Abstract
Introduction:
Home Treatment Service (HTS) is a frailty Hospital at Home team that provides comprehensive geriatric assessment, hospital level diagnostics and treatments for people in their own home. This option of care is often suitable for people living with frailty or those with advance care planning directing them to community options. The team is dynamic with many disciplines within it to allow urgent care provision. HTS is formed of ACPs, SAS Doctors, Therapists and Healthcare Assistants.
Referrals used to be from direct clinician discussions only via a triage line but more recently has increased links with the Acute and Ambulance Trusts. This has been done by providing a Multi-Disciplinary Team that interacts with visiting paramedics via a clinical navigation hub (CHUB).
Home Treatment Service now has two main referral routes as illustrated by the infographic below. The CHUB has increased the interaction with paramedics in real-time when people are experiencing an acute medical crisis. This has allowed rapid access to senior clinical decision makers allowing holistic patient-centred joint decision-making with often complex and frail patients.
Method:
61 HTS referrals from the CHUB were compared with 61 direct clinician referrals from December 2023 to February 2024. The NEWs score, length of stay (LOS) and Advance Care Planning (ACP) documents were analysed.
The data also interprets the index of deprivation codes for all patients using the 2019 survey. 1 is the most deprived LSOA (Lower Super Output Area used to compare) and this score is a measure of deprivation based on measurements of seven different domains.
Results:
The average LOS under HTS via the CHUB was 2.61 days and 3.65 days for direct referrals.
27% of NEWS scores from the CHUB were high compared with 14% from direct referrals.
48 out of the 61 (78.6%) patients identified as requiring HTS by the CHUB had no ACP documents (the presence of a DNAR was not counted as this does not give community options). 37 out of 61 (60.6%) had no ACP on direct referral to HTS triage.
NEWS SCORE
CHUB HTS Referral
Direct HTS Referral
Low and Medium
45
51
High
17
9
The source of referrals were analysed further to consider the geographical areas that patients were referred from by considering the English Indices of Deprivation 2019 data available (Indices of Deprivation 2015 and 2019 (communities.gov.uk)). This was to allow consideration of any difference in access to either referral route according to markers of socioeconomic deprivation.
48 out of the 61 (78.6%) patients identified as requiring HTS by the CHUB had no ACP documents (the presence of a DNAR was not counted as this does not give community options). 37 out of 61 (60.6%) had no ACP on direct referral to HTS triage.
Conclusion(s):
Referrals directed to HTS proactively from the CHUB have a higher percentage of NEWS scores that would require hourly observations and access to urgent medical assessment. The CHUB explores community options while weighing benefits and risks of transfer to hospital in real time.
The Length Of Stay between the two referral sources is not hugely different and suggests that HTS are identifying patients requiring similar management regardless of source of referral.
The CHUB gives options to patients with fewer advance decisions recorded to support the direction of their care during a medical crisis. The CHUB allows HTS to access a different group of patients who may not have had routes to HTS enabled previously.
The pattern of spread of cases across the Indices of Deprivation groups are not hugely different between the referral routes. This may be because referrers consider social factors when referring or because of the acuity found during assessment.