Peterborough Community Rehabilitation Schemes Martyn Parker
Peterborough Hospital at Home Established 1987 Provided home care for patients Initially used by for hip fracture patients and after hysterectomy
Peterborough and Hospital at Home Became established as leaders in the field in 1980 s Pryor GA, Williams DRR. Rehabilitation after hip fractures, Home and hospital management compared. J Bone Joint Surg 1989;71-4:471-4. Pryor GA, Myles JW, Williams DRR, Anand JK. Team management of the elderly patient with hip fracture. Lancet 1988;20:401-3. Anand JK, Pryor GA, Morgan RTT. Hospital at Home. Health Trends 1989;21:46-8. Pryor GA, Williams DRR. Rehabilitation after hip fractures, Home and hospital management compared. J Bone Joint Surg 1989;71-4:471-4. Meeds B, Pryor GA. Early home rehabilitation for the elderly patient with hip fracture; the Peterborough Hip Fracture Project. Physiotherapy 1990;76-2:75-7. Parker MJ, Pryor GA. The Peterborough effect and Hospital-at-Home. Geriatric Medicine 1991;21:23-5. Parker MJ, Pryor GA, Myles JW. Early discharge after hip fracture: prospective 3-year study of 645 patients. Acta Orthop Scand 1991:62:563-6. Todd C, Williams R, Pryor G, Parker M, Myles J. Early discharge to 'hospital at home' after fractured neck of femur: psychosocial factors. In Brenner G, and Weber I (eds). Health Services Research and primary health care. Cologne: Deutscher Artze-Verlag. 1991. Hollingworth W, Todd C, Parker MJ, Roberts JA, Williams R. Cost analysis of early discharge after hip fracture. Br Med J 1993;307:903-6. Byers D, Parker M. Early home rehabilitation for the patient with a hip fracture. Br J Occupational Therapy 1992;55:351-4.
Criteria for discharge of hip fracture patients to Hospital at Home Medically stable Able to get in/out of bed Walk to toilet or commode
Meet and greet person Night sitter for one night Provided at home Three to five times a day patient aids Home physiotherapy Occupational assessment District nurse review General Practitioner review only if needed Access to re-admission to the orthopaedic ward
Care level adjusted to suit patient Over 2-3 weeks number of visits progressively reduced as the patient improves Social services arranged to take over as required
Difficult cases Trial at home for those in which unsure if will be able to manage Joint care package with social services Used for patients with dementia and delirium
Early results For the Peterborough scheme 60% of patients who were admitted from there own home were discharge to the scheme after a mean hospital stay of 8 days For the subsequent Stamford scheme 80% of those admitted were discharged to the scheme with a mean stay of 8 days
Unsuitable cases Fitter/younger patients Those with a full care package Those needing institutional care (10%) Those who do not survive the hospital admission (5%)
Early results of Hospital at Home Initial results were excellent Patients just disappeared from the ward Few readmission Preferred by patients Small overall financial saving
Long term results of Hospital at Home Service became over used Unable to talk so many patients Delays to discharge as waited for availability Now probable of negative effect as delays discharge
70 Peterborough Hospital at Home 60 50 40 30 20 58 53 44 44 46 51 46 42 47 35 48 45 32 25 40 29 27 15 30 50 20 23 21 20 21 10 0 18 10 8 11 11 10 11 12 10 10 11 12 14 14 14 14 15 16 16 16 16 14 15 16 13 87 88 89 90 91 92 93 94 95 96 97 98 99 0 1 2 3 4 5 6 7 8 9 10 11 % to early discharge Days to discharge
90 84 Stamford Hospital at Home 80 77 70 60 50 40 30 20 48 51 58 42 36 45 38 43 30 19 21 10 0 16 8 9 10 12 14 10 11 13 14 15 16 12 99 0 1 2 3 4 5 6 7 8 9 10 11 % to early discharge Days to early discharge
Conclusions Potentially the service can be fantastic Must be adequately staffed and monitored Has to be the ideal method of rehabilitation for this group of patients after surgery