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Hospital at Home (Wandsworth and Merton)

Providing hospital-level and holistic care at the patient's residence
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Originally set up with a focus on supporting early discharge from hospital, Hospital at Home was the first community trust-led virtual ward in the country. Hospital at Home allows patients to get the care they need at home safely and conveniently, rather than being in hospital.

The Hospital and Home team provides a standardised specialist service to prevent admission and enable an earlier discharge of patients hospital into the community requiring ongoing nursing, therapist, and medical care.

It offers a multi-disciplinary triage, assessment, and care intervention for people identified as able to return home but requiring some additional medical monitoring in addition to support from health and/or social care, within the boroughs of Merton and Wandsworth. 24 hr vital sign monitoring is offered via the Central Remote Monitoring Hub which is located at Croydon Health Service NHS Trust.

The multi-disciplinary team provides the following:

  • Patient assessment and review
  • Investigations: Point of care bloods, US, ECG
  • Interventions: IV/IM Antibiotics,Point of Care Testing, ECG’s Oxygen weaning
  • Monitoring: Remote monitoring of vital signs (HR, Sp02), weight
  • Anticoagulation management
  • BM Monitoring and Titration

The Hospital at Home team comprises GPs, advanced nurse practitioners, advanced clinical practitioners, and nurses, as well as physiotherapists, occupational therapists, and pharmacists. All work together holistically to ensure patients receive high-quality care and work with other partners such as primary and secondary care, district nurses, and other internal teams, as well as social care partners, to ensure seamless care. 

All referrals must be discussed by a senior clinician with the Hospital at Home team to agree suitability and capacity.

Referrers should contact SPA. The telephone line are open seven days a week, 8am - 6pm Monday to Friday, and 10am - 6pm Saturday and Sunday. This line is for health and care professionals only.

Any contact from patients and relatives should go via the Merton or Wandsworth Single Point of Access (SPA) numbers:

Wandsworth SPA: 0333 300 2350

Merton SPA: 0333 004 7555

Criteria:

Patients declining admission after a full documented CLCH capacity assessment to make this decision, including relevant declarations signed. Recurrent admissions on a case-by-case basis. Any patient who would benefit from continuous home monitoring to support clinical decision making and treatment planning.

Inclusion criteria:

  • Expected treatment time 1-14 days
  • Client medically stable, but needs ongoing intervention and monitoring to be optimised
  • Client is able to manage at home with the current support that is in place

Exclusion critera:

  • Experiencing mental health crisis, substance misuse
  • Safeguarding reason, not safe to return to usual residence
  • Requires interventions that can only be provided in hospital 

Any contact from patients and relatives should go via the Merton or Wandsworth Single Point of Access (SPA) numbers:

Wandsworth SPA: 0333 300 2350

Merton SPA: 0333 004 7555