Hospital at Home is a short-term, targeted intervention that provides a level of acute hospital care in an individual’s own home, or homely setting that is equivalent to that provided within a hospital. There are a variety of different models and approaches through which such a service can be delivered, but all share certain key features:

• The severity of the condition managed (such as sepsis, pulmonary embolism) differentiates Hospital at Home from other community service provision as well as the input from senior clinical decision makers.
• A hospital consultant acts as senior decision maker and responsible medical officer, sometimes with the help of other grades of medical staff
• It covers short, time-limited acute episodes of care and is not intended to prevent access to specialist acute care. Patients are treated as though admitted to hospital, but managed within their own home
• It provides urgent access to hospital-level diagnostics, such as endoscopy, radiology or cardiology where necessary
• It provides a different level of interventions, such as access to intravenous fluids and oxygen
• Care is delivered by multidisciplinary teams of healthcare professionals complying with current acute standards of care, and
• It complements other community-based health and care initiatives which support patients to remain in their own homes.

Consultant led refers to the patient care. Ultimate responsibility and decision making for patients in a Hospital at Home service sits with a consultant, as it would in an acute hospital setting. The leadership of the service itself can be agreed locally.

No – most services are not 24 hours. Care of the patients outside of operating hours can for example sit with the Out of Hours teams.

Equipment required will depend on the range of interventions being delivered and skill mix of staff involved in the service.

This list of equipment to consider when starting a service is a useful guide.

A literature review of the published evidence on the overall effectiveness and safety of Hospital at Home initiatives for older people with frailty was undertaken to discover any lessons that can be learned on what works, for whom and why. The key points from the review and the supporting evidence are summarised below, and you can read more on the Hospital at Home website. 
The emerging evidence on effectiveness and safety suggests that compared with usual hospital care:

• Costs of Hospital at Home are generally lower than inpatient care, but there can be considerable variation in costs between services. Hospital at Home services have the potential to be a cost-effective option.
• Patients generally express high levels of satisfaction with the service.
• Hospital at Home may reduce the likelihood that patients will be living in residential care in the months after the acute episode, and
• Hospital at Home can be delivered safely without increased rates of death or re-admission to acute care.

Hospital at Home is delivered by acute specialists, however, due to the nature of providing care in the home it uniquely sits at the interface and commissioning of a service should ideally take place within the Integrated Joint Board.
A Hospital at Home service serves people within the community, and should therefore align with existing services such as virtual wards, community teams and enhanced community teams.
In some areas Hospital at Home is delivering a service which bridges acute and community care – with models being developed where clinicians follow their patients across traditional acute/community divides. Hospital at Home should be patient focused rather than service led.

The time commitment to set up a service is mostly through engagement with key stakeholders such as service users to raise awareness of the service, and to find out the needs of the population. Engagement should focus on providing a service which complements existing services both within the community and acute sector to develop seamless links and pathways.

It is vital for a Hospital at Home service to build relationships and engagement with primary care to ensure effective communication, especially as there may not be linked IT systems. Clear referral criteria are key to running a successful service, with clear referral pathways into other services to ensure seamless transition and clear communication. Clear pathways and strong relationships ensure each patient gets the best individualised care.
Successful services demonstrate the ability to maintain contact with GPs, ensuring that any important clinical information is relayed in a timely manner, including a detailed discharge letter with an updated medicines reconciliation.

An example of a typical day in a Hospital at Home service can be found in the 'A day in the life of a Hospital at Home nurse' blog. 

Teams across Scotland have shared examples of service design, SOPs, and guidance. These can all be found on the Hospital at Home Implementation Toolkit on the ihub website. New resources developed by teams are also shared on the Hospital at Home Microsoft Teams Community. To request access to this community please contact a member of the team.

This changes depending on the needs of the service, and how long it has been operating and what other services exist locally. A typical service may consist of:
• Medical consultant (for example a Geriatrician)
• Team lead
• Nurse practitioner
• Advanced Nurse Practitioner
• Nursing staff
• Service Coordinator
• AHP staff (including OT, PT, Pod, SLT, Dietetics)
• Admin support
• *ANP and NP posts can be trainee Annex 21 posts as it can be difficult to find staff that are fully trained
Watch the staffing focused Virtual Learning Session for more in-depth information. Other resources relating to staffing can are available in the 'Your Team' section of the Hospital at Home Toolkit.

Areas of deprivation may have higher referral rates to Hospital at Home services.
COVID-19 has seen a shift towards patients requesting an alternative to hospital admission, and may increase referral rates. Patients living in rural areas where it could be difficult to access medical care could see Hospital at Home as a favourable option.

You may wish to run a small pilot and focus on a particular area where you are planning to launch the pilot. For example, a geographical area with a high hospital admission referral rate or a group of patients that require admission regularly.

Experience of existing teams tells us that it is best to start small and then develop as you progress in order to shape your service to the needs of your population, followed by a gradual roll out to encompass your designated area.

Hospital at Home requires the support of care providers to safely manage patients at home. These patients are at high risk of admission and it it is vital that connections are made with social work.

There may be concerns that using care at home may increase referrals to their service, however, experience in existing services shows that this is not necessarily the case. Working with care providers can ultimately allow autonomy for the patient to stay at home in contrast with patients discharged from an inpatient stay in hospital who may require a greater package of care due to institutionalisation.

Experience also shows that patients who are kept at home do not lose their existing care packages, as this can be continued while the patients are under the care of Hospital at Home.