Acute Care in Your Own Home

Imagine receiving hospital treatment without even staying in hospital. In the last two years, that’s what 1,700 NHS patients have experienced under a ground-breaking acute hospital-at-home scheme run by ORLA Healthcare. So how does it work and can it really help solve the crisis facing the health service?

They read like a list of potentially serious illnesses normally considered suitable only for treatment in a hospital setting. Indeed, if a doctor suggested staying at home with pneumonia, COPD or cellulitis, patients might wonder if it was time for a second opinion. But that’s exactly what’s happening with thousands of sick patients under a game-changing initiative run by Essex-based ORLA Healthcare, in collaboration with NHS trusts.

Between May 2014 and March 2016, more than 1,700 patients who would normally be admitted to hospital or were already existing in-patients were instead cared for in their own homes by an ORLA team of medical and nursing specialists. The patients ranged in age from 18 to 102 – although nearly two thirds are aged 71 or more – and as well as the conditions mentioned above also suffered with upper and lower respiratory infections, needed post-operative care and had severe electrolyte imbalances due to vomiting and diarrhoea.

In the past, such patients would spend several days in hospital, taking up valuable resources that could be devoted to treat other in-patients. Under the new scheme, things are a bit different.

First, a patient judged to need hospital admission is assessed by ORLA’s clinical team to see if they are suitable to be cared for at home. A care plan is then agreed with the patient, who is taken home, where all necessary equipment and medicines are then delivered. Within an hour of getting home, a member of the ORLA clinical team visits. From that point on, the patient follows the same care pathway as in hospital, receiving up to six visits a day from the clinical team. Telemedicine monitoring equipment records blood pressure, pulse and oxygen saturation levels and the results are transmitted straight to an ORLA Consultant. ORLA’s Doctors, Nurses and Health Care Assistants administer treatments to the patients and are available 24 hours a day. Finally, when the patient has recovered, they are discharged back to the care of their GP.

Technology plays a crucial part too.

Patient notes are all electronic and accessible to all ORLA staff round-the-clock. Clinical staff, meanwhile, use iNurse technology to manage patients in their own home. This allows them to record and communicate patient information at the point of care using phones or tablets, sharing it with Consultants based in ORLA’s clinical office. In short, it’s just like being in hospital – without being in hospital.

So what are the advantages?

David Harrop, CEO of ORLA, says: ‘Imagine that, as a patient, you have a choice of being at home surrounded by your own things, your own family, your own furniture and your own bed, as opposed to being on a ward that has a lot of clutter and noise 24 hours a day. ‘You’re going to get a better night’s sleep and your family and others can visit you anytime without restrictions. And if you want access to the kitchen to make yourself a drink, it’s your home. On a ward, things are done for you, including when you can have your drink. For older, frail patients, putting them in a hospital bed can increase disorientation. But by being in a familiar home setting – whether it’s their own home or a nursing home – they are more actively in control of their life. Very few patients have said no they don’t want to transfer their hospital treatment to ORLA’

Patients may be keen. But what has been the reaction within the NHS and how does the scheme work at a practical level?

Jackie Row, ORLA’s Director of Nursing and Clinical Services, says working side-by-side with Trusts’ own medical teams is vital to the success of the initiative. ‘A patient who comes into the emergency department will be seen initially by the trust nursing and medical staff. We have spent a lot of time working with the Trust medical staff so they understand our processes and pathways. So quite early on in that patient’s journey it may be that people are beginning to think they could be cared for in their own home.’

The idea is discussed with the patient and three streams of assessment then kick in. The ORLA Consultant undertakes a full medical assessment, the ORLA nursing team assesses the patient’s nursing needs and finally home risk assessments and a risk management exercise are carried out. Jackie says: ‘Then there is a formal handover from the Trust consultant staff to our consultant staff and we assume clinical responsibility for that patient at that point.’ At home, various staff will attend the patient – depending upon their needs. These range from nursing staff, healthcare assistants and middle grade medical staff to consultants, physiotherapists and pharmacists. As they recover, the six visits a day will reduce. David says: ‘Nobody else is doing this in the UK on this scale, with our level of acuity, with our range of clinical conditions and being Consultant-led. There is something very satisfying about bringing something new into the healthcare system of this country. Our feedback from patients shows a very high level of satisfaction.’

Inevitably, the scheme is not suitable for all types of hospital patient. At the moment it focuses on those needing acute medical care or acute post-operative surgical care. Paediatric patients are not covered by it and ORLA does not manage obstetric cases. ‘But there is nothing to say that future care could not encompass all of those,’ says Jackie. ‘This is just the beginning and there are many more things that we could do as time progresses. Even immediate transfer home after surgery, or patients requiring ITU set up, could be delivered in the future.’

So is ORLA’s model simply a fancy bit of innovation or a blueprint for the future of healthcare delivery in the UK?

David concludes: ‘We have to rethink how we deliver care and medical treatment to our population. These demographic changes, particularly in the over 65 years old over the coming decades and advances in medical treatment and advances in technology mean we have to adapt and can do things differently, we can’t keep doing what we did before and try and make it work. So we have to think outside the box and come up with new ways of delivering services. I believe that much of the work that Simon Stevens (NHS England chief executive) has initiated is very much in a response to that. The Royal College of Physicians’ Future Hospital programmes is also very much in keeping with the need to do things differently. Meanwhile, integrated care organisations are looking at how to deliver better services.’

By Pat Hagan

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