Expansion of Acute Care at Home - A Quality Improvement (QI) Project

Background The AC@H is a Consultant Geriatrician led Multi Disciplinary Team, operational since 2014, that provides hospital level care for people in their own place of residence. Demand for the service exceeded capacity therefore a quality improvement project was undertaken to increase capacity by 50%. Methods Guidance sought from QI team and engaged with key stakeholders, including patients and their carers. We process mapped current practices and we evaluated existing resources; staff and point of care testing. We developed an in-reach service to Emergency Departments in acute hospitals, increased multi-disciplinary recruitment and introduced virtual assessment. Results In reach referrals increased by 113%. Inappropriate referrals from hospital were reduced by 25%. There has been a 38% of increased accepted referrals overall. Conclusion Overall our project has been successful. Utilisation of QI tools helped us narrow down the areas which we can positively impact and implement a change. Room for improvement remains and the project is ongoing, we plan to improve pathways with the Northern Ireland Ambulance Service. We have also implemented a pilot for General Practitioners to refer all person’s over 65 with frailty directly to us to achieve our aim of 50%.