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GENERAL PRACTICE: Suzanne H Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care BMJ 1998; 316: 1796-1801 [Abstract] [Full text]

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Gillian E Mead   (10 July 1998)

Untitled 10 July 1998
Gillian E Mead Send response to journal: Re: this article	Hospital at home Editor Two randomised controlled trials recently reported that `hospital at home' schemes were effective and acceptable when compared with standard inpatient care [1,2]. The majority of the patients in both studies had undergone surgical procedures and were discharged early with appropriate support. One study also randomised patients in the community to either `hospital at home' or inpatient care, but the results from this subset of patients were not reported separately [2]. An alternative form of `hospital at home', whereby patients with minor self-limiting illnesses in the community are assessed and managed at home, may complement early supported discharge, and may enhance the quality of care for elderly patients. Therefore, we established a pilot community resource team consisting of a geriatrician, a nurse practitioner, an occupational therapist and a physiotherapist. The team's role was to offer rapid domiciliary assessment and treatment of elderly patients at home, and to arrange additional support from agency nurses if required. From January to March 1998, 25 patients were referred by their general practitioners for possible admission to hospital and subsequent inpatient care. Of these, 13 were treated at home by the team. By preventing 13 admissions, there was a potential financial saving of over £30 000, even after taking into account the cost of establishing the team. Postal questionnaires demonstrated a high level of patient satisfaction, and most general practitioners wanted the team to continue to operate. We suggest that formal evaluation of community resource teams in the context of a randomised clinical trial is now required, and that such teams may be a viable form of `hospital at home'. [1] Richards SH Coast J Gunnell DJ Peters TJ Pounsford J Darlow M-A Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care BMJ 1998;316:1796-801 [2] Shepperd S Harwood D Jenkinson C Gray A Vessey M Morgan P Randomised controlled trial comparing hospital at home care with inpatient care. I: three month follow up of health outcomes BMJ 1998;316:1786-91 Gillian E Mead Senior Registrar in Geriatric Medicine, Western General Hospital, Crewe Road, Edinburgh EH4 2XU (Tel 0131 537 5000, email GEM@skull.ed.ac.uk) Susan Gardiner Nurse Practitioner, Royal Victoria Hospital, Craigleith Road, Edinburgh EH4 2DN Roger G Smith Clinical Director, Royal Victoria Hospital, Craigleith Road, Edinburgh EH4 2DN