Linda Mackintosh describes how understanding what really matters has helped NHS Lothian reduce the number of elderly people having to be admitted to hospital.
Edinburgh Royal Infirmary in NHS Lothian focused on the conversation on what really matters to elderly people when they present to the Emergency Department. Elderly people and their families expressed the wish for the elderly person to return to their home if possible and not be admitted to hospital, particularly if they were confused as a result of a cognitive impairment.
In response to this, we developed the Home First Practitioner Service. This service is designed to promote admission avoidance and is made up of a team of experienced nurses located in the Emergency Department and the Acute Medical Unit. They work closely with the patient, their family and promote integration with multidisciplinary teams including Hospital at Home and our community health service colleagues and social care staff to allow us to discharge the patient safely home rather than admit them to one of the hospital wards. To do this, the staff identify those patients who require one to two medical interventions which can be administered safely in the community, to facilitate discharge.
The service began in January 2018 as a temporary winter period initiative and due to its success, is still in place running 7 days a week from 7am to 7pm. It has had a significant impact on patients’ care experience and the team are avoiding admission of approximately 50% of the patients they see.
This service demonstrates our continued focus on person-centred care.
~ Linda Mackintosh, NHS Lothian