Urgent Community Response and Camden Hospital at Home previously Rapid Access Services (UCR, Virtual Ward, D2A) incorporates three pathways:

• Urgent Community Response (previously Rapid Response)
• Hospital at Home (consultant geriatrician-led acute care)
• Discharge to Assess (D2A), a therapy-led hospital discharge service.

Urgent Community Response

The UCR service offers attendance by a senior nurse, paramedic, physiotherapist or occupational therapist within two hours of referral for acute or sub-acute medical needs.

Examples of suitable conditions include:

• blocked catheter
• carer breakdown (direct access to an adult social care worker)
• cellulitis
• chest infection
• COPD exacerbation
• COVID-19
• dehydration
• delirium 
• falls
• frailty
• haematuria
• head injury (simple, requiring dressing)
• heart failure
• unstable diabetes
• UTI (the service does not dipstick the urine of 65+ year olds to rule infection in or out)
• patients who require hospital admission but refuse to go (patient must be aware that the RAS service would provide a sub-optimal clinical outcome).

This is not an exhaustive list and, if uncertain, call the nurse/paramedic in charge to discuss the patient's needs.

Hospital at Home (step-up)

Offers a20-bed, consultant-led care for people over the age of 18 who would otherwise be admitted to acute hospitals.

The service supports patients of a higher acuity or clinical complexity than those supported by Urgent Community Response (UCR) where the primary focus is to enable a two-hour response to patients in the community. 

Falls pick-up service

A therapy-led falls pick up service. If patients are on the floor and have no obvious injuries, the service is able to attend the patient's property and pick them up using specialist equipment. A therapy review will then be provided,

Discharge to Assess (D2A)

The Discharge to Assess model focuses on a 'home first' principle and is comprised of three different pathways, with all referrals accepted from any hospital and processed by the Integrated Discharge Team (IDT).  

• Pathway 3: for patients being transferred to long-term care such as a residential care home or nursing home. 
• Pathway 2: discharge for patients to a location for a short-term period for rehabilitation and reablement, before returning home.
• Pathway 1: for patients going home from hospital. This pathway is operated in conjunction with Camden Adult Social Care. Same day  assessments will be based around the patient's level of function, environment and care needs to support independence at home. 

Eligibility Criteria

Inclusions

Adult patients (aged 18+) requiring immediate health or social care treatment who can be managed at home (or are in a nursing/residential care home) to prevent admission to hospital.

Additionally, those who:

• are a Camden resident or registered with a Camden GP and living in Westminster or Brent within one mile of the Camden border
• are non-housebound or housebound
• would likely avoid admission to hospital (A&E or main frame) if RAS has input (if not at risk of admission, not suitable for service).

Hospital at Home (step-up)

• aged 18+
• residents of Camden
• pre-medically optimised or at high risk of immediate (re-)admission 
• have an expected length of stay in Camden hospital at home of up to 14 days. 

The service will case manage patients during their stay under the hospital at home and make any necessary referrals. Typical patients will be older people living with frailty in crisis, including:

• falls (with or without injuries)
• delirium
• heart failure
• infection

Exclusions

• primary presenting complaint of a mental health nature or due to drug/alcohol abuse
• emergency conditions requiring 999/A&E
• home environment unsafe for visiting practitioners
• decline/refuse service/do not consent
• not at risk of admission to hospital (A&E or main frame)
• not contactable by GP (you must have spoken with the patient prior to referring to the service to make them aware of the team's attendance and to gain consent for the referral).

Please note: Camden Hospital at Home has additional inclusion and exclusion criteria, but this is managed internally. 

Self-referrals from patients or their unqualified carers are no longer accepted to the UCR pathway unless known to the team within the last 48 hours and with the same clinical presentation. This is in response to a number of self-referrals being inappropriate and using up resources, patient safety and follows similar agreements in other NCL boroughs and pan-London.

How to Refer