Case Study
Frimley Park - Hospital@Home
Introduction
Established in April 2021, Frimley Health NHS Foundation Trust Hospital@ Home (H@H) Frailty service is a rapid community response team covering Hampshire and Surrey. It was setup as part of the NHS England (NHSE) Virtual Wards programme, meeting the requirements of the NHS Long Term Plan (2019) which includes the Ageing Well Strategy and sets out the need to provide personalised care.
The Virtual Ward is a safe and efficient alternative to NHS bedded care that is enabled by technology, including point of care testing (POCT). The aim is to support patients who would otherwise need hospitalisation with acute care, monitoring and treatment in their own home; or to reduce the length of hospital stay. A further aim is to help people live well at home for longer with more input into the care and support they receive.
Operational efficiency
The Frimley Park H@H team adopted the LumiraDx point of care testing Platform and CRP test strips to support real-time decision making on the need for antibiotic treatment in frail, acutely unwell patients in virtual wards. Point of care testing avoided the need to return with samples to base hospital and deliver to the lab, giving a delay of several hours (or overnight) for lab results, which might then require a change to the antibiotic treatment and an additional visit to the patient.
The LumiraDx Platform is fully portable, battery-operated, and simple to use which makes it ideal for community and mobile testing. The team use the same lithium heparin sample as for other POCT testing (direct fingerstick samples can also be used, avoiding the need for phlebotomy) and provides lab-quality test results in 4 minutes. In addition, the LumiraDx CRP test strips can be stored, and transported, at room temperature (2 – 30°C) allowing added convenience for community testing.
Cost saving
The clinical impact of POCT CRP in the Frimley Park H@H service was demonstrated in a cohort of 26 patients.
(Equivalent to approximately one week’s worth of H@H patients requiring CRP testing).
- A point of care CRP test done in the patient’s home changed the antibiotic treatment decision in 23% of patients (6 out of 26).
- Five patients avoided IV antibiotics (4 were given an oral prescription and 1 did not require any antibiotics); negating the need for and risks of IV access.
- One patient was escalated to be given IV antibiotics immediately as a result of their CRP result.
- In 46% of patients (12 out of 26), the availability of a POCT CRP avoided the need for an extra home visit by the team.
- In 50% of patients POCT CRP improved the safety of care and helped avoid hospital admission, at a cost of up to £3914 per patient.*
*NHSE 2019/20 National Cost Collection: National Schedule of NHS Costs.
Outcomes
The ability to provide timely results to inform treatment decisions during the first home visit reduces the need for follow up visits, allowing the team to see more new patients, and helping to avoid unnecessary and undesired hospital admissions that are not in the patients’ best interests.
There are further benefits to patient safety, patient and staff experience and satisfaction, antimicrobial prescribing and stewardship, and reduced requirement for additional visits. Moreover, the virtual ward set-up has alleviated pressures on other services such as hospitals, GPs, and phlebotomy services.
A recent patient feedback survey showed that 100% of respondents gave positive feedback about the service. Laboratory-quality POCT diagnostics enable management of complex patients in their own home and offer patients greater autonomy in their choice of when and where they receive treatment.
BetterHealthExperiencesOutcomes
Supporting healthier lives, for individuals, communities and wider society.
Enabling responsive, personal relationships between patients and care teams.
Controlling and reducing costs to help ease pressure on healthcare budgets.