Dorset County Hospital NHS Foundation Trust

Seven Day ServicesWorking in partnership to reduce avoidable

admissionsAcute Hospital at Home

Patricia Miller, Acting CEO, DCHFTShane Cowan, Urgent and Emergency Care Manager,

DCHFTRuth Davis, Assistant Commissioning Manager, Dorset

County Council

Trust Profile• Dorset County Hospital is a small DGH located in a rural

community. West Dorset catchment population of c240,000

• The Trust provides Renal Service to Dorset and parts of Somerset covering population of around 800,000.

• Inpatient bed base – 368 including Maternity; workforce - 3,000 multi-professional staff.

• Good relationships with health and social care; CCG support for innovation.

• Focus on integrated care pathways and expansion into community.

• Annual turnover of £150m

Challenges• Serves a number of rural localities. Significant

travelling distances for patients to visit the hospital for treatment

• 26% of the population is of retirement age• Elderly patients have multiple long term conditions

leading to frequent readmissions and high care needs in hospital and the community

• Some Models of Care are very traditional• Financial sustainability• Recruitment and retention in acute key specialties

and community • Lack system or pathway integration

What is Acute Hospital at Home

Three areas of service:

•Acute hospital at Home Daytime•Roaming Night Service•Alternative Offer

Acute Hospital at Home Daytime• The Service is Consultant led and enables patients

to remain at home and receive ‘inpatient’ care from a multi disciplinary team

• The Service is supported by Consultant delivered service across the hospital and community seven days per week.

• The initial service provided ten virtual beds in the community

• Patient cohort using this service includes conditions such as COPD, bronchiectasis, IV Therapies, frail elderly with multiple LTCs

Acute Hospital at Home Daytime

The Service has during its inception faced a number of challenges•Recruitment to fixed term posts during the pilot phase. This was managed by offering secondments •Residential Home in Reach has proved difficult as they are not registered for nursing care. We are currently working with the CCG to address this.• Drug management – ensuring robust clinical

governance has been challenging particularly in the absence of electronic prescribing

Acute Hospital At Home Daytime

• Handovers for night team – comprehensive handover was essential to both the site team and the roaming night team

Roaming Night Service

• 2 carers covering a geographical area

• Supports the Alternative Offer and Acute Hospital at Home Services

• Links to ED, SWAST, Careline and 111 if required

• Case Study – Ms & Ms F

Alternative Offer

• National Care home capacity expanding – Dorset admissions similar pattern

• 46% placements directly from a hospital setting• Case studies: Ms S & Ms B

What have we achieved?KPI Baseline Objective Achieved Emergency length of stay 6.8 5.8 5.8

Residential home placements 23 6 4

(3 nursing, 1 residential)

increased Consultant presence/senior decision making

10 hours weekdays 12 hours weekdays 12 hours weekdays

6 hours 12 hours 12 hours weekends weekends weekendsPatient experience NA 95% 95%

Emergency admission reviewed by Consultant within 14 hours

100% Within 24 hours

100% within 14 hours

100% within 14 hours

Reduction in beds NA 10 beds 10 beds

Softer targets for improvement• Patient experience, especially for vulnerable

patients has improved. Experienced Based Design used to ensure service was patient centred.

• Care closer to home was achieved particularly for frail elderly at risk of hospital admission

• Partnership working between health and social care has been strengthened

• Integration has been the key result, with health and social care providing seamless care for patients

Next steps• Service has been identified by NHS England

Innovations Team as good practice.

• Service funded recurrently by Dorset CCG

• Acute Hospital at Home Service to be expanded to 15 beds admitting frail elderly and increased further during next winter. Decision made not to close these beds as emergency admissions rising by 5% year on year. However winter escalation capacity has been reduced from 26 beds to 13 beds.

• Alternative offer to be expanded to cover the county