The North Middlesex University Hospital (NMUH) Adult Hospital at Home (AH@H) step-up service allows adult patients to safely and conveniently receive acute care at their usual place of residence, including care homes. The service provides acute consultant-led care delivered by a multi-disciplinary team at home as an alternative to hospital admission. 

The team includes consultant physician 3 hrs/day, advanced clinical practitioners (ACPs), nurses, nurse associate, heart failure CNS, physiotherapist, pharmacist, a case-finder and an administrator. 

The service operates daily from 8am to 8pm, with weekend cover provided by consultant and nurses. Outside these hours, an on-call rota is covered by ACPs with escalation to hospital on-call team if needed. Care is generally provided for up to 14 days.

Care delivered includes:

• geriatric assessment 
• clinical and nursing review 
• medication titration
• therapy input, such as physiotherapy, occupational therapy
• point-of-care tests, ECG, bloods, bladder scan 
• IV therapies (as capacity allows) 
• advance care planning and palliative care support 
• bowel management, wound management, INR bridging, pain management.

Remote monitoring is available using Doccla (HR, BP, Sats, ECG, temperature). 

The service accepts a wide range of patients who may otherwise require acute inpatient hospital care, but some common conditions accepted across NCL include (indicative):

• acute kidney injury (AKI)
• acute respiratory infections/exacerbation, such as chest infection/pneumonia, COPD, viral illness
• delirium (resolving delirium)
• cellulitis
• falls
• frailty (acute frailty)
• heart failure
• UTI or pyelonephritis
• infections including IV antibiotics from the 2nd dose 

NMUH specific pathways:

• fractured neck of femur (#NOF)
• elective orthopaedic
• surgical
• sickle cell

This is not an exhaustive list - if uncertain, call the service to discuss.

Medicines Management

GP practices please note that all medicines governance and oversight sit with the Hospital at Home team while the patient is under its care. This is to reduce the risk of duplication or other incidents. If you have any questions or concerns about an individual patient please contact the service directly. Medicines supply arrangements may vary across H@H. 

GPs will receive a discharge summary when the NMUH AH@H episode of care is complete.

For further details on Hospital at Home in north central London, visit the NCL ICS website.

Eligibility Criteria

Inclusions

• Aged 18+
• Enfield resident and registered with an Enfield GP
• Care home and nursing home residents in Enfield (registered GP does not necessarily have to be in Enfield) 

and

• At home and in a crisis that requires acute level care

and

• It is practical, safe and feasible to treat the person at home, with the expected clinical outcome unless person has capacity and chooses to remain at home, and accepts that the clinical outcome may be suboptimal. 
• The AH@H and acute hospital team agree that risks are manageable for staff, including risks related to violent behaviour, environmental hazards or verbal abuse.
• The patient and/or their carer give consent for AH@H care. In cases where the patient lacks capacity, a best interest decision should be made. 

Exclusions

• Injured and requires emergency care intervention, such as long bone fracture, spinal fracture
• Needs hospital-only acute/complex diagnostics and/or clinical intervention, unless they have capacity and decline admission
• Mental illness behaviours that pose a risk to themselves or others, or require an assessment under the Mental Health Act  
• Is in a crisis due to substance abuse (including alcohol) is intoxicated or is still withdrawing  
• Requires nasogastric tube or suctioning
• New requirement of POC
• Acute crisis has resolved, and person requires only rehabilitation and/or chronic disease management  
• Acute crisis has resolved, and person requires only step-down/social care needs only
• Requires more than three times per day medication administration, that can only be administered by the AH@H nursing. 
• Safeguarding reasons, it is not safe for a person to remain at usual place of residence
• Expected length of stay > 14days.

How to Refer

GP referrals are accepted Monday to Friday, 9am-3pm with 2-hour response.