A new tool to measure acuity in the community: a case study
The provision of acute healthcare within patients own home (i.e. hospital in the home) is an important method of providing individualised patient-centred care that reduces the need for acute hospital admissions and enables early hospital discharge for appropriate patient groups. The Hospital in the Home (HitH) model of care ensures that this approach maximises patient safety and limits potential risk for patients. As HitH services have seen record numbers of patient referrals in the past 2 years, there is now a greater need to measure and understand the acuity and dependency levels of the caseload. Through an expert clinician development process at one NHS trust, aspects of procedural complexity, interdisciplinary working, risk stratification and comorbidities were used to quantify acuity and dependency. This paper uses a case study approach to present a new method of measuring this important concept.
Accurate measurement of acuity and dependency within all areas of healthcare is an important component of clinical governance and is directly linked with patient safety (Griffiths et al, 2020). There are validated approaches to the measurement of acuity and dependence, which have been developed within the acute inpatient hospital setting and have enabled individual units to describe their patient population more accurately and provided evidence for the workforce requirements within specific areas (e.g. acute medical wards, emergency departments and critical care units) (Vranas et al, 2018; Yiadom et al, 2018; Griffiths et al, 2020). In the community setting, there are unique challenges in understanding and accurately measuring acuity and dependency. This is mainly due to patient complexity owing to the environment and varied patient populations requiring community healthcare (David and Saunders, 2018). Previous studies have attempted to predict hospital readmission using validated tools, but these are not routinely used (Lee et al, 2016; Armitage et al, 2021). Some patients are eligible for management in their own homes rather than having to go to hospital. For these patients, the assessment of acuity and dependency is an extremely difficult but integral component of assessing and managing risk to patient safety (Abrashkin et al, 2019).
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