Patient at Home service reflects on pivotal role in COVID-19 response
The Patient at Home service at The Princess Alexandra Hospital NHS Trust has had a pivotal role in the extraordinary response to the coronavirus (COVID-19) pandemic by supporting patients in their own homes.
The team of doctors, nurses, pharmacists, healthcare assistants and administrative staff (pictured above) support patients in the community with a range of illnesses and conditions, who require hospital level care but are suitable for this to be given at home. This includes medical and post-surgical care for adults with respiratory, urology, orthopaedic, gynaecology, and cardiology conditions, and others. This may be, for example, urinary tract infections, osteomyelitis (an infection of the bone), cellulitis (an infection of the deeper layers of skin), and infections that exacerbate chronic obstructive pulmonary disease (COPD) – each patient is assessed on an individual basis.
The service has a range of benefits including the improved wellbeing of patients in a familiar, comforting environment; enhancing patient flow; and reducing the need for patients to be admitted to hospital. This has been particularly important in effectively managing the demands of coronavirus (COVID-19).
The service has also tested and treated several patients with coronavirus (COVID-19) at home since the beginning of March. This means that patients are able to safely recover in their homes, under the care of the Patient at Home service clinical team, following all infection prevention and control guidance to ensure the safety of our patients and our people. The team treat patients with many acute conditions and necessary medical equipment is provided, including oxygen treatment when required.
From April 2019-March 2020, the service has treated 670 patients at home, equating to 8042 bed days saved (days patients would have otherwise spent in an acute hospital setting).
Once patients have been referred to the Patient at Home service by their hospital doctor, a member of the team will talk to the patient about the care required and jointly agree a care plan. When the patient is transferred home, the medicine and equipment that is required is provided by the service and brought to the patient's home when the clinical team visit. The service take referrals from hospital consultants and from the West Essex Single Point of Access Hub, which manages calls from service providers, including GPs, to refer care needs to the most appropriate provider.
Each patient remains under the care of the named hospital consultant and on a daily basis is managed by the Patient at Home doctor, who will either telephone or visit the patient at home to check on their progress and provide an update on their care. Each patient receives daily nursing visits and has access to speak to the team seven days a week. The daily visit schedules are supported by senior nurses that report back to the team on site and where required patients will be referred for ongoing support from other health or social care professionals. Once the patient has recovered, they are discharged back to the care of their GP or the relevant community service.
Hiral Patel, head of the Patient at Home service, said: “We work to ensure that the patient is treated in the right place, by the right person, at the right time.
“We were proud as a service to achieve finalist status at the Health Service Journal (HSJ) Awards in 2017 for the ‘Acute, Community and/or Primary Care Services Redesign’ category, following the introduction of the service in 2016.
“The service continues to evolve and we are actively working with system partners to further enhance integrated care for our local population. We receive a great deal of complimentary feedback from our patients, which means so much to us.”
Thilo Pillay, senior pharmacist/clinical specialty support of the Patient at Home service, said: “We monitor and supply medication to patients who require long-term antibiotics in the community.
“We are also looking at novel ways of administering intravenous antibiotics in the community using 24 hour infusion devices.”
Leanne Worrall, lead nurse of the Patient at Home Service, added: “We are committed to providing a high quality service for patients in their own homes that helps them in their recovery.
“To work as part of a team that delivers hospital based acute care to patients out in their own homes is an absolute privilege. We look after a wide range of patients out in the community with differing conditions, and our patients have nothing but praise for our service and are always glad that they are able to receive their treatment at home.”
Patient story 
Patricia Connell, 69, from Broxbourne, Hertfordshire, a retired solicitor who is married with two children and two grandchildren, has recently benefited from the service. Patricia (pictured, right) was treated for an infection and exacerbation of bronchiectasis, a long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection. This is the twelfth occasion that Patricia has been cared for by the Patient at Home service, after previous stays in hospital due to bronchiectasis and asthma. She was first visited at home by the Patient at Home team in November 2017, after developing a lung infection.
Patricia said: “I was first diagnosed with bronchiectasis in about 2013. I have been on long-term oxygen therapy since 2014, and I have had non-invasive ventilation at night and in the afternoons for three years. I also have a nebuliser. I have been with the Patient at Home team for about three years as I have a number of quite serious conditions and have recurrent infections.
“About three years ago I was admitted to The Princess Alexandra Hospital via A&E for inpatient treatment and I was finding it quite difficult. My need for oxygen varies from two litres up to six litres. In a hospital situation this means the nurses have to turn the oxygen up and down for me as the controls are not in reach due to the design of the equipment, whereas I usually can do this myself at home. I was feeling quite stressed about being in hospital and it was suggested that the Patient at Home team could help, which meant I was able to go home later that day and be treated at home three times a day with intravenous antibiotics, I finished the course and felt much better.
“Before I was under the care of the Patient at Home service, I was going into hospital fairly regularly with chest infections and by the time I got to hospital they were often quite serious. I would end up in A&E or resuscitation. Now I am being referred to the Patient at Home team every seven weeks. They assess me and give me intravenous antibiotics in my own home, which is much less stressful. I’m sleeping in my own bed and controlling my own oxygen when I need to. I can also use my nebuliser when I need it. With the regular contact with the service, my infections are caught at an earlier stage than before so that they don’t become as major an infection.
“It was so wonderful that the team were able to come and look after me at home during the coronavirus (COVID-19) pandemic. I’m a shielded patient and I had been inside my house for several weeks before I got the next infection. I spoke to my consultant and the Patient at Home team came to see me. It was obviously very worrying having people coming into the house, but they came with masks and gloves and other protective equipment. They were so professional, kind and caring, I had full confidence in them. They have been really good, keeping me from needing to go to hospital and they have enabled me and my family to have a much more stress-free life. With my conditions, my quality of life would not be as good were it not for them. They have been a life saver.”