Hospital At Home self-referral pathway: admission avoidance for older adults

Introduction

Hospital At Home (HaH) provides hospital-level care for acute medical issues that would traditionally require admission to an acute hospital bed. HaH with Comprehensive Geriatric Assessment has shown similar outcomes for older people living at home compared to those admitted to an acute hospital (Shepperd et al, 2021). Referral to an alternative from hospital can be slow and tortuous. To reduce this delay and chance of hospital admission, a pilot scheme of patient self-referral into HaH was launched in May 2024 and evaluated.

Method

Anonymised patient data was retrospectively collected from the electronic patient record software system for patients, EPIC, placed on the self-referral pathway between May 2024 and May 2025. Data on demographics, medical issues, clinical frailty score (CFS) and pathway utilisation was collected in the six months following enrolment onto the pathway. Patients in residential or nursing homes were excluded as referral is based on an alternative pathway.

Results

Fourteen patients aged 65 years or older (56%) enrolled on the pathway in the first 12 months. All patients had a CFS of 4 or above with the mode CFS 7 (range 4-8). The most common index medical condition for enrolment was frailty (28%) followed by heart failure (24%). 11 patients activated the pathway (79%). 5 patients activated the pathway themselves (45%) and 6 relatives or carers activated the pathway (55%). The mean length of stay for patients activating the pathway for a frailty index condition was 2 days (range 1-5, mode 1).

Conclusions

This pilot has demonstrated the utility of a self-referral pathway for older adults living with frailty. Further work is required to understand why so few patients in this group were offered the pathway, encourage greater use and evaluate further how the pathway is being utilised by patients and carers.