Clinicians pioneer 'hospital at home' service for children with infections

Doctors and nurses in Southampton have developed a pioneering scheme which enables children with complex infections to be treated at home.

The paediatric outpatient parenteral antibiotic therapy (p-OPAT) service, led by clinicians at Southampton Children’s Hospital, sees young patients who are medically stable but in need of prolonged intravenous (IV) – through the vein – antibiotics to be managed safely outside of hospital.

Previously these patients would be admitted for the duration of their antibiotic course which, for some patients, could last for up to six weeks.

The service is the brainchild of Dr Sanjay Patel, a consultant in paediatric infectious diseases, and Helen Green, a clinical nurse specialist in paediatric infectious diseases, but is delivered in partnership with community nursing teams from across Hampshire, Dorset and Wiltshire.

The team treats children suffering from a range of severe infections, including bacteria in the blood or blood poisoning, bone and joint infections, heart infections (endocarditis), brain abscesses, meningitis and central line infections.

“For patients, p-OPAT means earlier discharge from hospital, a quicker return to education and lower risk of developing healthcare-associated infections,” explained Dr Patel. “In terms of parental benefit, they have one point of contact with a clinician or clinical team, rapid return to domestic life to care for other children and resume work and less time spent waiting around on hospital wards.

“But, most importantly, children have to continue receiving the same quality of care at home as they would have received in hospital.”

As part of the scheme, Ms Green became the first and only nurse in the country trained to insert peripherally inserted central catheter (PICC) lines in children under general anaesthetic using ultrasound guidance.

PICC lines are used to provide antibiotics through one of the large veins in the arm for a prolonged period of time and help to speed up discharge from hospital.

Once a patient has returned home, their customised antibiotics continue to be made in hospital and administered by community nursing teams.

For children on complicated antibiotic therapy, innovative pump bags known as elastomeric devices are being used to administer antibiotics continuously over a 24-hour period.

During a 21-month study period, 80 patients who would have required a total of 1,472 hospital bed days were treated at home, resulting in an estimated cost-saving of £250,000 to the health service.

When surveyed, 100% of families agreed or strongly agreed p-OPAT was preferable to inpatient treatment.

“This service really is at the forefront of patient innovation in the NHS and has resounding benefits for patients, their families and healthcare organisations,” explained Dr Patel.

“It is a fantastic example of hospital and community professionals working together to improve patient care and we are delighted feedback has been so positive among parents and their children.”

He added: “In addition to developing the first p-OPAT service in the UK and producing national guidelines, the model is now being adopted by other leading children’s hospitals in the UK and that is a real credit to Southampton and our region.”

Posted on Monday 3 August 2015