Background:

Hospital at Home (HaH) is a health care model in which patients who need acute care are treated at home as an alternative to hospital admission. EPICENTRE (Emergency Point of Care Testing and Treatment in Care Homes and at Home) is an innovative service in Sandwell and West Birmingham Hospitals NHS Trust NHS (SWBH) in the West Midlands built on the HaH model of delivering medical care. The service involves acute care clinicians working with community care teams to assess and manage patients who need acute care by giving them hospital level treatment in their usual place of residence.

Delivering high quality and frailty-attuned acute assessment and ongoing care outside congested acute hospitals is a very high priority for the NHS. The Covid-19 pandemic demonstrated that hospital-based acute assessment capacity can be rapidly saturated leading to delays in assessment and treatment at Emergency Departments and on Acute Medical Units.

EPICENTRE is potentially an important resource to help reduce the pressure on hospital admission in Sandwell and West Birmingham NHS Trust. If successful, the model can be quickly replicated within the West Midlands and in other regions to benefit patients and the NHS. Evaluation of the model as it evolves will support an evidence-based approach to build knowledge and inform decision making to improve delivery and enable replication.

Aims and Objectives:

This study aims to conduct a formative evaluation of EPICENTRE in order to establish the progress of the care model and suggest ways in which its development and implementation model can be improved.

Objectives:

1. To gain an understanding of the components and scope of the EPICENTRE intervention

2. To describe how EPICENTRE is being implemented (process of implementation and describe them using TIDierR (Template for Intervention Description and Replication) (10) guidelines

3. To assess the proportion of patients registered to EPICENTRE who are nevertheless admitted to hospital

4. To explore the barriers and facilitators of implementation

5. To consider and explore further improvement of the intervention

This study is part of the wider project ‘Acute assessment and medical care without hospital transfer for older people living with frailty’.

Methods:

This is a mixed methods study comprising:

· Conversation with key informants and desk review of documentation describing model processes and standard operating procedures

· Extraction and analysis of routinely collected data

· Semi-structured interviews with a range of stakeholders

· Focus group discussion with stakeholders using the nominal group technique

Main Results:

The study is at the data collection stage.

Outputs will include a Rapid Insights Guide, an implementation guide to inform other integrated care systems within the region and beyond, a publication in peer review journals and a conference presentation. Findings will also be disseminated to patients and their carers through local patient groups using contacts of the PPI lead and as advised by our public contributor panel.