Delivering Acute Care at Home for Older Adults: A National Survey of UK Hospital at Home Services
Abstract
Introduction:
Older adults are the main users of acute hospital medical care, however the hospital environment poses well-documented risks, particularly for older adults living with frailty. Hospital-at-homes (HaHs), also known as virtual wards, provide acute multidisciplinary healthcare at home for acute medical conditions. However, little is known about current operational models and clinical activity. This study aimed to describe current UK HaH services and their clinical activity on a national scale.
Methods:
A national cross-sectional survey of UK HaHs conducted in April 2025, describing operational structure and patient caseload on a single day.
Results:
Forty-seven HaHs completed the survey. 2,131 virtual beds were identified, with 59% of beds occupied on the survey day. 81% patients were aged over 65 years and 31% had moderate-to-severe frailty (CFS ≥6-9). 52% of the patients were referred from acute hospital inpatient areas. Other sources of referrals included community practitioners (28%), hospital outpatients (11%), care homes (5%), ambulance services (4%) and patient/carer self-referrals (1%). All services provided medical consultant oversight and multi-disciplinary team input. 91% offered in-person visits, with 64% offering out-of-hours in-person reviews and 67% offering out-of-hours telephone reviews. 68% of services used virtual monitoring. Point of care tests offered included ECGs (87%), blood tests (62%) and vital sign monitoring (41%).
Conclusions:
HaHs exist across the UK, providing an alternative to acute hospital admission for acute medical conditions. Many patients treated by HaHs are older adults living with frailty. Services are providing both admission avoidance and early supportive discharge. However they vary widely, particularly in operational hours, access to hospital-level diagnostics and treatments, and appear underutilised. As HaHs expand across the NHS, greater standardisation is needed to ensure all patients receive healthcare equivalent to hospital-level care at home.
Comments
Great project
Very interesting project. I feel that we need to make this known to the community and how patients can be referred to these pathways, as many patients will still present in A&E despite maybe being suitable for this type of care.