1. The Midlothian Enhanced Rapid
Response Team (MERRIT) has now
been operational for over a year now,
since starting in the summer of
2014.
This report shows some of the data
collected in the last 12 months,
starting from September 2014, for
the Hospital at Home component of
the team.
Once again, we thank NHS Lothian
and Midlothian Council for their
continued support - being part of a
truly integrated service we believe is
a key to ongoing success!
Hospital at Home
Update Autumn 2015
From the Midlothian Enhanced Rapid Response
and Intervention Team
All referrals to:
0131 270 8890

2. The Hospital at Home team are part of the wider MERRIT service and aim to offer an
alternative to hospital admission for frail older patients. Although designed as a service
for the over 75s, many of our patients are younger than this and we are happy to discuss
any potential patients via the referral number 0131 270 8890.
We can offer daily visits to patients to undertake assessment and observations, adjust
medication, give advice and support to them and their families and to make
recommendations on ongoing management. We can give intravenous medication when
necessary, for example furosemide or once daily antibiotics and we can administer
subcutaneous or intravenous fluids when appropriate. Our patients have access to the
same range of Radiology and Cardiac Physiology testing that the traditional hospital
inpatients do.
In fact, many patients do not require invasive management, but do benefit from the daily
input from the highly trained nurse practitioners on the team. We've recently expanded
the team and are in the process of recruiting an additional doctor to the team to help
provide medical cover throughout the year.
The H@H Team:
Consultant Physician:
Dr Patricia Cantley
Nurse Practitioners:
Maureen Lucas Mackintosh
Sharon Dempsey
Nancy Warne
Brenda Halley
Laura Young
Clinical Support Worker:
Keith Dowson
Administrator:
Margaret Newlands
in addition to the fully integrated Rapid Response Team
of OTs, Physios, Pharmacist, administrators and care
workers.
Who are
we and
what do
we do?

3. Autumn
stats!
Referrals to Hospital at Home Team Oct 14 - Sept 15
Referrals to the team have continued to increase over the last year. Most recently there has
been an increase in referrals from the acute admissions unit at the Royal Infirmary.
Source of referral to Hospital at Home Team
We present here some statistics gathered
over the last 12 months for interest and
discussion.
Over this period, 255 referrals were received
and 225 patients "admitted" to our 10 bed
"virtual ward".

4. Age of patients referred to
H@H team Oct 14 - Sep 15
Referrals come predominantly from the GP practices around Midlothian. Sometimes the GP
requests only the H@H service, but in many cases the full team is required, including
therapists and carers. The exact needs for any individual can be determined by the duty
worker receiving the phone call. The Penicuik practice at Imrie Place was the highest
referring practice in the last 3 months - 26 patients from a total of 78 in July to Sept 2015.
Sex of patients referred
to H@H team Oct 14 -
Sep 15
Did we avoid a hospital
admission?
data from Oct 14 - Sept 15
It is always a hard question to judge whether a patient has avoided an acute hospital
admission by being admitted to our service. In this chart, a subjective judgement has been
made that the patient would otherwise have required full inpatient assessment and
treatment. However, in many cases it is less clear - with a number of patients who refuse
acute admission, but who would almost certainly have become more unwell without
intervention and needed emergency admission within a day or two of their initial refusal.
Future research may help to clarify this issue. We look forward to participating in the
National Multicentre Randomised Controlled Trial to help answer these key questions.

5. Reasons for referral to Hospital at Home Oct 14 - Sept 15
Reasons for referral to Hospital at Home tend to be mostly for the management of
acute infections and also for the treatment and monitoring of cardiac and renal
failure. We have, however, also dealt with a number of other conditions, including
hepatic encephalopathy, intravenous fluid support in a post operative patient,
deteriorating diabetic control, possible stroke, fast atrial fibrillation and
investigation of possible malignancy amongst other conditions. In each case, an
assessment of the risks and benefits of hospital admission versus home treatment
are carefully weighed up in conjunction with the patient and their family's wishes
and goals. Each day we review with the patient and their family whether home
treatment is still the right option for them. Around 10% of patients are admitted to
hospital from our service, mostly arranged by us to an appropriate ward for them.
If a patient is dying, we work closely with the local District Nursing and Palliative
Care services, and aim to hand over care to these professionals for the intensive
support they can provide in the final days of an illness. We also have a strong
working relationship with the Community Hospital in Midlothian where we can
admit patients for end of life care in a compassionate environment.
Patients are usually kept on our "virtual ward" for no more than a few days. We
hope that by working with the Information and Statistics Division in the forthcoming
months to have more precise data on this, and also on admission rates to acute
care from our service.

6. The Future?
We are working increasingly closely with the Royal Infirmary Acute Admissions Unit to
take people straight home who might otherwise have required admission. This has
become possible in part because of the newly instigated Medicine of the Elderly daily
ward round in that unit and we hope to see many more people able to benefit from an
early discharge from hospital.
Other news from the team here is that this month (October 2015), the nurses have
started to work full shift patterns to cover seven days a week and be available until 8pm
each evening. This has already made a big difference to a number of people and we hope
it will allow more referrals on Thursdays and Fridays that might otherwise have been
turned away. We thank the geriatricians of South Edinburgh and East Lothian for their
support in this and the provision of medical cover.
Any questions - do get in touch!
Email patricia.cantley@nhslothian.scot.nhs.uk
or call in to see us upstairs in Bonnyrigg Health
Centre.
And of course that number again:
0131 270 8890