East Lothian H@H

Hospital At Home East Lothian

Hospital at Home East Lothian (ELSIE)

Hospital at Home (H@H) is a multidisciplinary acute care team based in East Lothian Community Hospital, made up of Advanced Nurse Practitioners, Nurse Practitioners, Clinical Support Workers, Consultants, Specialty Doctors and Clinical Fellows with Pharmacy support and close links to OT and PT. We use a holistic, multi-disciplinary approach during the acute phase of an illness.

The service covers all East Lothian postcodes.

COVID 19: Please see guidance on the Pan Lothian Hospital at Home Page on

Hospital-at-Home support to manage COVID-19 in community

Who can refer:

We take referrals from Primary Care, we take referrals from Secondary Care to support early discharge, and are happy to discuss referrals from allied health professionals if appropriate.

Who to refer:

Referral to Hospital at Home should be considered for patients with an acute medical issue who can be assessed and managed at home, or who do not wish a hospital admission.

The referral criteria remain:

Patient is aged over 18 and is resident in East Lothian
Patient would otherwise require admission to hospital, but can be assessed and managed at home
Priority is given to patients with a background of complex needs or frailty
Patient is safe at home (either self-caring or with existing package of care and/or supporting family)
That the patient / Next of Kin are aware of the referral to H@H as an alternative to hospital admission

Types of conditions that we typically manage:

Infections requiring parenteral antibiotics
Respiratory exacerbations requiring oxygen, nebulisers, PT, antibiotics, steroids
AKI requiring IV/SC fluids
Heart failure requiring intensive management including IV Furosemide if necessary
Delirium
Anaemia and weight loss (if haemodynamically stable, no acute bleeding)
We are happy to discuss any referrals where you feel H@H may be able to help.

Further Information

Our capacity to administer IV therapies is caseload dependent. We prefer once daily administration, but in certain circumstances can deliver a twice daily regime.

Depending on the complexity of our caseload we may not be able to see new patients on the day of referral.

Hospital at Home will usually take over responsibility for INR testing and Warfarin dosing if the patient is under our care. This may involve contacting the practice for the most recent INR results, if these are not available on the lab system (e.g. if patient using NPT and system such as RAT).

Who not refer:

Exclusion Criteria:

Cardiac chest pain
Acute stroke
Acute Asthma
Suspected DVT/PE
Trauma including suspected fracture(s)
Acute toxicology
Acute surgical emergencies including abdominal pain
Patient or family unwilling to stay at home
New more than 2 litres oxygen requirement (if unsure if patient is suitable due to oxygen issues, then please ask to be put through to Nurse coordinator to discuss)
Social Issues Only
Therapy needs only (please refer to Prevention of Admission team)

How to refer:

UPDATED JUNE 2021 WITH NEW REFERRAL PROCESS

In order to improve the referral process from September 2020 we will now be taking patient referrals via the Flow Centre. This will bring us into line with the acute sector and other Hospital at Home services, and will hopefully be a smoother referral process.

We ask that all GP referrals go through the Flow Centre. They will take the patient’s details and will check that the patient meets the referral criteria for Hospital at Home.
The Flow Centre number is the same as for all other Flow Centre referrals: 03000 13 4000 (Option 1 then Option 4)
The patient should then be referred via Sci-gateway- ELCH > Medicine of Elderly > H@H
Please do not send a Sci-gateway referral without also calling Flow Centre as the inbox will only be checked intermittently and your referral may not be acted on in a timely manner

We know that in some circumstances both GPs and ourselves in Hospital at Home appreciate the chance to talk directly and so Flow Centre will transfer the call to the Hospital at Home Nurse coordinator in the following circumstances:

For all calls after 3pm
For all calls at the weekend
For all calls for urgent assessment
For all calls where advice only is required
For all calls where the referrer is uncertain if H@H is the appropriate place to refer to

If capacity has been reached for that day the flow centre will give the referring clinician an opportunity to discuss with the H@H team the best course of action which may be GP initiated management with H@H follow up the next day or admission.

If you have any problems using this service or would like to give us any feedback on how it can be improved, please contact us via eastlothianhospitalathome@nhslothian.scot.nhs.uk.