Service evaluation exploring Acute Care at Home Services and conventional hospital admission for older people in Northern Ireland.

Barry Tierney, V Melby, Stephen Todd

Research output: Contribution to journalArticlepeer-review

Abstract

Abstract Aims & 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 aging 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 one-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 whilst under Acute Care at Home care. Patients admitted to the Acute Care at Home services experience a reduced length of stay, 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
JournalJournal of Clinical Nursing
DOIs
Publication statusAccepted/In press - 5 Apr 2021

Keywords

  • acute care at home
  • Older people
  • morbidity and mortality
  • Service Evaluation

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