Overview
Bromley Hospital at Home provides acute-level assessment, treatment and monitoring in a patient’s own home/nursing home/care home, to prevent or shorten a hospital admission:
The Bromley Adult’s Hospital at Home service is an innovative healthcare initiative developed by the One Bromley Local Care Partnership.
We aim to provide you with the same care at home that you would receive in hospital. Many people prefer to be cared for at home rather than in hospital. This service can enable you to avoid going into hospital or help you to get home sooner by providing hospital-level care at home.
We are a team of nurses, doctors, hospital and hospice consultants and other healthcare professionals from hospital and community health services in Bromley.
We take care of patients at their homes and monitor their vital signs and outcomes remotely. The team works 7 days a week, 365 days a year, 8:00am to 8:00pm.
The service is currently provided by Bromley Healthcare, Princess Royal University Hospital, St Christopher’s Hospice, and Bromley GP Alliance.
What is this service and who is it for?
The service is for adults aged 18 and over who are registered with a Bromley GP and who need hospital care that can be provided at home.
Treatments include a range of acute interventions, including remote monitoring, intravenous antibiotics/diuretics/fluids, blood monitoring, respiratory care, urgent palliative care, urgent frailty care, pain management and many others. It means you can receive the best possible care in the comfort of your own home rather than being in hospital.
To use the service your referring clinician will ensure that you are medically stable, can understand and consent to treatment in your place of residence, and will be able to call us in the event of feeling more unwell.
How can I get a referral?
You may be referred by your GP, community health team or hospital clinician. They will discuss the service with you to ensure you are happy to have your hospital care at home.
The Hospital at Home team will review the referral and confirm back to the referring professional whether the service is suitable for you and your healthcare needs. We will then be in touch with you directly ahead of our first visit.
Intravenous Therapies
The Hospital at Home Intravenous Therapies pathway is for patients who are not under the care of a District Nurse, or where the complexity of care means that extra support is required.
The team will administer intravenous therapies, such as antibiotics, diuretics, or fluids, for you in your own home, check to see that the treatment is working and agree with you on what needs to happen next.
The service accepts referrals for starting or continuing a patient’s course of intravenous antibiotics at home for:
- Cellulitis
- Lower respiratory tract infection
- Urinary tract infection
- Other patients agreed with us and, as appropriate, Princess Royal University Hospital Microbiology Team
Patients in the community may need to visit the Princess Royal University Hospital to have their first dose of antibiotics or have an intravenous line inserted. Where that is the case we will arrange this with the patient.
Please note our palliative pathway may use sub-cutaneous interventions where appropriate.
Download the Intravenous Antibiotics patient information leaflet:
Your stories
Take a look at the following videos; they tell the stories of some of our patients:
Gareth’s story:
Frieda’s story
Joseph’s story
For professionals
FAQs
What is the Bromley Adult's Hospital at Home service?
The service is a One Bromley Local Care Partnership initiative. It is for patients with a working diagnosis only. Bromley Adult's Hospital at Home is a consultant-led multi-disciplinary team currently comprised of nurses, doctors, hospital and hospice consultants and other healthcare professionals from Princess Royal University Hospital, Bromley Healthcare, St Christopher’s and Bromley GP Alliance. It is based within Bromley Healthcare’s Urgent Community Response directorate.
The service provides acute-level assessment, treatment and monitoring in a patient’s own home/nursing home/care home, to prevent or shorten a hospital admission. It has expertise in acute respiratory, frailty exacerbation and urgent palliative care requiring response within 48 hours.
It is for patients who:
- are safe/appropriate to be at home and have a working diagnosis
- have an expected length of stay of up to 7 days (or 14 days for intravenous antibiotics)
The service takes clinical responsibility for the episode of care, except for longer courses of intravenous antibiotics as agreed between the service and individual hospital consultants.
It works with patients in their own environment, with their informal carers and others to confirm treatment plans. It utilises remote monitoring technology for vital signs and patient reported outcomes and has access to ECG, bladder scanner and blood monitoring at bed-side. Through close working with the PRUH Frailty Unit the service can arrange hospital level diagnostics (e.g. x-ray, CT scan) during the patient’s episode of care where a working diagnosis has already been made.
The service is relatively new and is constantly growing and adapting. It has a core offer but welcomes conversations about patients you think could benefit from its care for an acute medical issue.
For patients referred from hospital, please:
- Consent the patient for treatment at home
- Confirm that the patient can summon help in the event of deterioration (either self or via a carer)
- Double-check which address the patient will be going home to
- Ensure the referral has been accepted by the Hospital at Home team prior to discharging the patient – see “How do I refer” below
- The discharge summary is sent to Hospital at Home
- Patients have their medications prior to leaving hospital
- Patients have the Bromley Adult's Hospital at Home patient information leaflet
For patients referred from the community please:
- Consent the patient for treatment at home
- Confirm that the patient can summon help in the event of deterioration (either self or via a carer)
- Call to make the referral and confirm acceptance – see “How do I refer” below
- Patients have the Bromley Adult's Hospital at Home patient information leaflet
Who can refer?
The service currently accepts patients aged 18+ with a Bromley GP referred by:
- GPs
- St Christopher’s Hospice
- Urgent Community Response – Rapid Response
- Princess Royal University Hospital
Other provides – please call 0208 315 8722 Option 1 in the first instance to discuss the patient requirements. The patient must have a working diagnosis to be referred to this service.
What acute needs does the service currently support?
- Patient monitoring for change in medication/rescue pack
- Infection - initiation and continuation of IVAB OD, BD, TDS for
cellulitis
lower respiratory tract infection
urinary tract infection
other patients agreed with us and, as appropriate, Princess Royal University Hospital Microbiology team
- Decompensation of frailty
Frailty assessment and planning
Note - please do not refer for non-resolving delerium
- Heart failure
Decompensated chronic heart failure (fluid overload) requiring oral or intravenous diuretics
- Respiratory
Bronchiectasis
Covid-19
Exacerbation of COPD, pneumonia, LRTI or other respiratory conditions requiring remote monitoring of O2 sats
Nebuliser loan and wean
Intravenous Antibiotics
Note - patients with long-term oxygen therapy must be using their prescribed dose and within their target saturation range
Note - patients should not be referred due to asthma exacerbation
- Palliative
Urgent needs assessment to stabilise end of life patients at home (where beyond GP scope of practice)
Urgent symptom control beyond GP’s scope of practice and where unknown to St Christopher’s
Urgent support to patients and their families
- Dehydration
Requiring intravenous or subcutaneous fluids and/or blood monitoring
Oral rehydration protocols
- Diabetes
Monitoring control plan (insulin and blood glucose monitoring)
The service has this core offer but welcomes conversations about patients you think could benefit from its care.
View the PDF of typical presentations, exclusions and interventions
What interventions does the service currently offer?
- Remote monitoring
- IVAB – up to TDS
- Assessment and planning, including frailty and palliative
- IV diuretics and monitoring fluid off load in HF
- Acute monitoring and support of patients in relation to Insulin and blood glucose monitoring
- Wound management
- Pain management
- Bladder and bowel monitoring
- Catheterisation
- Hydration protocol
- IV fluids
- Bloods monitoring (at bedside or via lab): renal function, infection markers
- Nebuliser therapy support and monitoring
- Medication review
- Syringe driver
- Prescribing
- Chest physio
- Bladder scans
- ECG
View the PDF of typical presentations, exclusions and interventions
What remote monitoring can be provided?
Bromley Adult’s Hospital at Home generally has good capacity for remote patient monitoring, with readings requested from patients up to three times a day.
Patients we have seen to date on this pathway, and where the technology works well, include observations following changes to medication, diabetic plan monitoring, and as part of respiratory, heart failure and frailty care. Patients monitor up to three times a day.
The remote monitoring kits can monitor NEWS2 plus blood sugars, peak flow, weight and Kardia ECG (the latter not suitable for patients with heart implants). Patient health status questionnaires can also be requested.
Where patients are admitted to this pathway, equipment will be sent to patients at home and they will be telephoned by the service to be onboarded. The expected length of stay with the service should be up to 7 days.
Please refer in the usual way (020 8315 8722, Option 1, ask for Hospital at Home). The service inclusion and exclusion criteria apply.
When does Adult Hospital at Home operate?
8am to 8pm, 7 days a week. Outside of these hours patients should contact 111 or 999.
Referrals currently accepted Monday to Friday 9am to 5pm.
How does the service work?
At the first visit, a risk assessment will be undertaken, observations taken, interventions administered and the patient record updated. Patients may also be issued with remote monitoring technology called Doccla.
At every subsequent visit, the patient will be reassessed, observations completed, interventions delivered and recorded on Bromley Healthcare’s electronic patient record (EMIS). Where a patient has remote monitoring technology the observations will be reviewed virtually by the clinical team. Readings that are missed or outside agreed parameters will be followed up by phone call, home visit, or escalation to hospital. Remote readings are also recorded in Bromley Healthcare’s electronic patient record (EMIS).
Patients are discussed in a multidisciplinary board round to ensure personalised care plans with appropriate escalation and de-escalation.
At the final visit, it will be confirmed that the patient is being discharged from the service. As appropriate, cannulas are removed by the team at the end of treatment. The team can re-site cannulas as needed. Longer lines such as a PICC line may require a hospital visit for removal which will be arranged by the team. The patient will be asked to send back the monitoring technology.
The patient’s GP will receive an electronic discharge notification via email, including any relevant information regarding onward referral and changes to medication.
What are the referral criteria?
Inclusion Criteria
- Aged 18+ and registered with Bromley GP
- Have working diagnosis
- Reviewed face to face in last 72 hours (includes video)
- Safe prior to Hospital at Home 1st visit (by 10am next day)
- Expected Length of Stay up to 7 days (14 days for IVAB)
- Patient can self-escalate via phone or carer
- Able to understand and consent to community treatment (or assessed in best interests)
Exclusion Criteria
- Immunocompromised/neutropenic
- Asthma – primary reason for referral
- Sepsis
- Non-resolving delirium
- Current intravenous drug or solvent misuse
How do I refer to the service?
GP Referrals
- Call 020 8315 8722 (Option 1) - request Hospital at Home
- Monday – Friday 9am to 5pm
- The triager will ask for a referral form available on the ROP for accepted referrals
St Christopher’s Hospice
- Self-triage against service criteria – liaising with palliative H@H clinician as required
- Hospital-based patient: Call H@H clinician to hand over
- Community patient: Create SystemOne E-workflow for internal referral to H@H Palliative
Urgent Community Response
- Liaise with Hospital at Home Triage via 020 8315 8722 (Option 1)
Bromley Healthcare Community Teams (e.g. District Nursing)
- Refer to Rapid Response in the first instance via 020 8315 8722 (Option 1)
Princess Royal University Hospital
- Use the referral form: Bromley Hospital at Home Referral Form and email as directed.
Other providers
- Liaise with Hospital at Home Triage via 020 8315 8722 (Option 1) in the first instance
What do I need to consider before referring for intravenous antibiotics at home?
In all cases consider whether an oral alternative would be suitable.
The services is for:
- Cellulitis
- Lower respiratory tract infection
- Urinary tract infection
- Other patients agreed with us and, as appropriate, Princess Royal University Hospital Microbiology Team
Hospital patients
Where stepping-down a patient from hospital, liaise with microbiology to ensure the minimal dosing regime and duration of antibiotics is prescribed.
A triager will call you back to confirm details of the referral and will ask for either:
- drug chart (ambulatory services) or
- electronic discharge summary (ward)
These should be emailed by the acute clinician to bromh.ucr@nhs.net copying in the patient’s consultant.
Please confirm acceptance to the service prior to discharge and that the patient leaves hospital with:
- Patient information leaflet
- Antibiotics
- Diluent
- Flushes
- Needles, syringes
- Giving sets and IV bags (if applicable)
- Sharps bin
- PICC/Midline dressings
The service has been set up for short courses of antibiotics (up to 14 days, up to TDS) however, if the service has capacity it may be able to take referrals for longer courses of antibiotics to support earlier discharges. This must be agreed in advance by triage and the team. Call in advance to check current capacity: 0208 315 8722. Longer courses require a named consultant who will perform reviews and advise on treatment plans e.g. diabetic foot team, orthopaedics. Remember teicoplanin for more than one week requires levels to be monitored.
Bromley Adult’s Hospital at Home Referral Form (for professionals only)