International learnings for innovative Hospital in the Home services
Published: 3 Aug 2016
Karen Titchener is the Clinical Lead and Deputy Head of Nursing for the innovative Hospital in the Home (HitH) Service at Guys and St Thomas’ NHS Trust. Karen has recently returned from travelling to Australia and New Zealand for four weeks to observe more established HitH services. Karen’s travels were funded by a Winston Churchill Memorial Trust Travelling Fellowship Award, in partnership with the Burdett Trust for Nursing.
HitH, a relatively new concept within the UK healthcare system, is a method of delivering multidisciplinary care within a person’s home for a variety of conditions. In the UK an ageing population with multiple co-morbidities has led to increasing pressure on health services. To cope with the increase in demand, and to help already overstretched acute services, there has been a rise in the development of admission-avoidance services such as HitH.
The UK has not been alone in developing such services, as a proliferation of HitH-type schemes has also taken place across the developed world over the last two decades. Such schemes have been reported to be at least equivalent to standard acute hospitalisation in terms of patient mortality and morbidity (Utens et al, 2013) and many report improved patient satisfaction and reduced costs (Spiliopoulos et al. 2008).
Through her Fellowship, Karen gained field experience and observed a diversity of teams in practice, enabling her to truly understand the establishment and operational running of their HitH services. She enriched her understanding of such crucial issues such as the skill mix of nursing staff required in a HitH service, with each service using senior nurses with Emergency Department ITU, or acute medical experience, as these nurses are very used to looking after acutely unwell patients and recognising acute deterioration.
Karen also learned how each state had Department of Health Guidelines around service delivery, clinical governance, and operational guidelines, with HitH teams well positioned in the local health structure to enable safe and effective transitions of care.
She was also able to spend time with Michael Montalto, an international expert in the field, which fortified her knowledge of the philosophy of HitH.
“It has been a real privilege and honour to travel under the name of Winston Churchill. This fantastic opportunity to visit and experience new ways of working in order to influence medical practice in the UK is really important. It will directly help us with the establishment and advancement of services where the focus is on better patient outcomes and experience, and operational efficiency, leading to a more sustainable NHS” -Karen Titchener
Since returning to the UK, Karen has begun writing a report on the HitH services she visited. She will use her findings to influence best practice guidelines and pathways, and will disseminate her research in her local NHS trust, in the nursing press and at national forums.
Notes to editors
The aim of the partnership is to improve the health and well-being of patients, a key element of the Medicine, Health & Patient Care category. The Burdett Trust makes grants in support of nurse-led projects, using its funds to empower nurses and make significant improvements to the patient care environment.