AimsThe 2012 NHS mandate made recommendations to improve the quality of care delivered to patients whilst also reducing their inpatient length of stay. In response to this, we developed a paediatric ...healthcare at home (HAH) service at our hospital in April 2014. This provides consultant led, nurse delivered acute care for paediatric patients in their own home.Patient safety and outcomes are paramount and the neonatal subgroup of patients is potentially the most vulnerable of the paediatric population.In this review, we therefore aim to examine the diagnoses and outcomes for neonates cared for utilising the HAH service during a 12 month period.MethodsThis was a retrospective study of all neonates identified from the HAH patient database over a 12 month period. The data set collected included clinical diagnoses, clinical outcomes and patient satisfaction. Parallel data collection was also undertaken for neonates cared for on the postnatal wards who could potentially benefit from being cared for utilising the HAH model.ResultsDuring the 12 month study period, 28 neonates were cared for utilising the HAH service representing 17% of the overall referrals. Collectively, they had 201 home visits and saved 108 inpatient bed days. All of the neonates received treatment with iv antibiotics, 100% needed to be administered more than once daily. There was one re-admission who subsequently completed their treatment at home following a 24 h period of observation as an inpatient. There were no adverse incidents reported and patient satisfaction was overwhelmingly positive: 100% of respondents would recommend the HAH service to friends and relatives.During the same 12 month study period, 68 clinically stable neonates were cared for on the postnatal wards with iv antibiotics for ≥ 5 days for presumed infection. Their diagnostic microbiology outcomes are detailed in Figure 1. This group collectively spent 409 bed days in hospital.ConclusionThe HAH model delivers a safe, effective, high quality clinical service for a selected group of neonatal patients. There is great scope for expansion as a significant number of babies on post- natal wards could safely receive their care utilising the HAH model.Abstract G172 Figure 1
A 50-year-old female was admitted because of nausea, vomiting, and cerebellar ataxia. Computed tomography scan revealed an enhanced mass accompanied with a cyst in the right cerebellar hemisphere. ...The mass situated in the subcortical region was removed. Histologically, highly vascular tumor cells lined the cavities. Postoperative radio- and chemotherapy were administered and the clinical symptoms improved gradually. Two months later, the patient complained of dyspnea. Chest X-ray on second admission demonstrated cardiomegaly. Hemorrhagic pericardial effusion amounting to 1000 ml was aspirated by pericardial puncture. Papillary clusters of tumor cells were demonstrated in the pericardial effusion. The patient died of cardiac failure. At necropsy solid tumors were located in the heart, lung, left inguinal region, and cerebellum. Histological diagnosis was mesothelioma arising from the heart. Primary pericardial mesotheliomas are rare; approximately 106 cases have been reported. Pericardial mesothelioma frequently spreads to the adjacent pleura and mediastinum, but distant metastases are extremely rare because patients with pericardial mesothelioma tend to die early due to cardiac failure or cardiac tamponade.
