Abstract
Introduction:
As awareness of hospital-associated deconditioning increases, services to prevent hospital admissions and provide discharge support for older adults are expanding, aiming to reduce admissions and the risks associated with prolonged hospital stays. A Welsh Government IQS titled “Older People and People Living with Frailty” published in January 2024 identifies a need to shift our health and social care system from prioritising reactive crisis management to a ‘place-based’, community-focused approach that emphasises proactive identification and management of frailty. The CTMUHB @Home Service (AHS) was instituted in 2017 to provide domiciliary and community-based care to patients at risk of hospital admission, covering Rhondda, Cynon, Taff Ely and Merthyr Tydfil.
Methods:
A retrospective review of patients discharged from the AHS between February and May 2024 was completed (n=345). Reasons for referral, diagnostic journey details, and patient outcomes were recorded. Alongside this, the IV Antibiotics Service register for the same period was analysed (n=48) to calculate the number of Bed Days saved and its associated cost effectiveness.
Results:
57% of referrals are related to patients’ risk of or recent falls, followed by 16% of patients with increased frailty who are approaching crisis. 8% of patients have been referred for the specialised services of the AHS, such as COPD reviews, discharge support, pharmacological optimisation, or follow-up blood tests. Most referrals originate from GPs, with other sources including facilitated discharges or WAST. Bed day costs saved from the IV Antibiotics Service are estimated to be £358,000.
Conclusion:
We now have a better understanding of the AHS’ monthly patient in and outflow. Although the substantial cost savings seem positive, it is still uncertain whether this conclusively measures the AHS’ cost-effectiveness. This understanding will help pave the next steps towards increasing awareness about the functions of the AHS as a hospital avoidance team focused on frailty.