Hospital at home – a review of our experience

INTRODUCTION: Hospital at home (HAH) is a service that provides home-based nursing and rehabilitation services whose aim is to prevent admission or to facilitate early discharge from care in an acute hospital. METHODS: We evaluated the effectiveness of early discharge hospital at home (HAH) schemes for hip fracture patients over a 27-year period in a district general hospital in the United Kingdom. A long-term database for audit and research purposes is maintained for all hip fracture patients admitted to Peterborough City Hospital. The data were analysed retrospectively and patients were followed up routinely for six weeks after discharge. RESULTS: As many as 8876 patients were admitted with a hip fracture between 1st January 1987 and 31st December 2014, of which 5512 patients were eligible for one of the two available HAH schemes. The proportion of eligible patients discharged to the HAH schemes, and their hospital stay and readmission rates were measured; 1786 patients were discharged to a HAH scheme. The proportion of patients discharged to the scheme progressively reduced from a maximum of 94% to a minimum of 13% over the study period. The length of hospital stay until discharge to the scheme progressively increased from a mean of eight days to 18 days. DISCUSSION: We conclude that HAH schemes can potentially reduce the length of hospital stay of hip fracture patients but continued resources and service organisation have to be provided to match the increasing demand to prevent the service from becoming ineffective.