Digitising the acute service based home assessment

Cost improvements and delayed discharges or ‘bedblocking’ are historical, ongoing and topical issues (Gaughan et al 2016). Crucial for many inpatients in the discharge pathway are access and home visits (Marks 1994, Parker et al 2002).

Many patients require Occupational Therapy home assessments prior to hospital discharge (Sheppard et al 2010). They are labour and resource intensive (Sampson et al 2014). Clinical practice also suggested that although necessary, arranging and conducting visits can delay discharges. It was hypothesized greatly reducing Occupational Therapists physically visiting homes could significantly reduce the costs to conduct the visits and speed up discharges.

A NHS Trust, University collaborative delivered a secure videoconferencing and note taking prototype. Immediate service deployment was inappropriate; consequently an emulation of adapted practice in realistic home assessment settings plus clinician and public consultation regarding the service development is reported. A registered volunteer or relative being the home visitor with a smart phone or tablet and the hospital based Occupational Therapist operating a personal computer. A simple to use videolink allowed the therapist to instruct the visitor and make notes.

Therapists evolved draft practice protocols progressively learning from scenarios that were increasingly better home assessment simulations. They also provided feedback for system improvements and obtained information to analyse cost and time savings.

Findings: Patients’ discharge could be quicker through an approach offering easier patient involvement in the home assessment. For stroke and wheelchair services there was an estimate of £81,000 savings per year without accounting for reduced bed blocking.