Service evaluation comparing Acute Care at Home for older people service and conventional service within an acute hospital care of elderly ward

Barry Tierney, V Melby, Stephen Todd

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Aims and Objectives: This study evaluated the impact of a consultant-led Acute Care at Home service in comparison with conventional hospital admission to a care of elderly ward. Background: Globally, there has been an increased demand for healthcare services caused by population growth and a rise in chronic conditions and an ageing population. Acute Care at Home services offer acute, hospital-level care in a person's own home. Five services have been commissioned across Northern Ireland since 2014 with limited research investigating their feasibility and effectiveness. Design: Quantitative design, using service evaluation methodology. Methods: A 1-year retrospective chart review was undertaken exploring admission demographics and post-discharge clinical outcomes of patients admitted to a Northern Ireland, Care of the Elderly ward (n = 191) and a consultant-led Acute Care at Home Service (n = 314) between April 2018–March 2019. Data were analysed using descriptive and inferential data analysis methods including frequencies, independent t tests and chi-square analysis. Outcome measurements included length of stay, 30-day, 3- and 6-month readmission and mortality rates, functional ability and residence on discharge. STROBE checklist was used in reporting this study. Results: Acute Care at Home services are associated with higher readmission and mortality rates at 30 days, 3 and 6 months. Fewer patients die while under Acute Care at Home care. Patients admitted to the Acute Care at Home services experience a reduced length of stay and decreased escalation in domiciliary care packages and are less likely to require subacute rehabilitation on discharge. There is no difference in gender, age and early warnings score between the two cohorts. Conclusion: The Acute Care at Home service is a viable alternative to hospital for older patients. It prevents functional decline and the need for domiciliary care or nursing home placement. It is likely that the Acute Care at Home service has higher mortality and readmissions rates due to treating a higher proportion of dependent, frail older adults. Relevance to clinical practice: Acute Care at Home services continue to evolve worldwide. This service evaluation has confirmed that Acute Care at Home services are safe and cost-effective alternatives to traditional older people hospital services. Such services offer patient choice, reduce length of stay and costs and prevent functional decline of older adults. This study accentuates the need to expand Acute Care at Home provision and capacity throughout Northern Ireland.

Original languageEnglish
Pages (from-to)2978-2989
Number of pages12
JournalJournal of Clinical Nursing
Volume30
Issue number19-20
Early online date3 Jul 2021
DOIs
Publication statusPublished - 1 Oct 2021

Bibliographical note

Funding Information:
This research was produced as part of an MSc Advanced Nurse Practitioner programme at Ulster University. The course was funded by the Department of Health Social Services and Public Safety. Author Barry Tierney was seconded onto this course by Western Health and Social Care Trust. The decision to undertake this research was solely chosen and influenced by the lead author Barry Tierney Department of Health Social Services and Public Safety. Western Health and Social Care Trust, Northern Ireland.

Publisher Copyright:
© 2021 John Wiley & Sons Ltd

Keywords

  • acute care at home
  • Older people
  • morbidity and mortality
  • Service Evaluation
  • General Nursing
  • General Medicine
  • frailty
  • care of elderly medicine
  • hospital at home
  • admission avoidance
  • older people
  • Length of Stay
  • Patient Readmission
  • Humans
  • Patient Discharge
  • Frail Elderly
  • Hospitals
  • Aftercare
  • Aged
  • Retrospective Studies

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