Hospital at home

Borders Ref Help Toolkit
NHS Borders

Hospital at Home provides medical and nursing input at hospital level to allow early supported discharge, or community referral to prevent admission to hospital.

Common presentations include exacerbations of chronic conditions like heart failure and COPD, acute infection (e.g. cellulitis, pneumonia, urinary tract infections), delirium, falls.

We can provide once or twice daily visits for IV medications, fluids, oxygen and nebulisers. The patient must be safe with their current level of support to stay at home or have additional support in place from friends/family or other services (e.g. Home First)

We accept referrals from the BGH, GP's and ANP's working in primary care and the ambulance service. We can provide same day review of community patients if referred before 3pm Monday - Friday, and next day review of hospital step downs 7 days a week.

Our opening hours are 0800-1800 7 days a week, and we currently cover Central Borders (Eildon, Cheviot and Teviot), we may also be able to expand into Berwickshire, depending on demand.  Currently we have no capacity to cover Tweedale.

Who to refer, who not to refer, how to refer

Who to refer

We will consider managing any ADULT patient that does not wish to attend hospital and is happy to have a clear anticipatory care plan. There is no age cut off. If you are unsure, please ring and discuss.

Who not to refer

  • Trauma
  • Surgical Presentations
  • Pregnant patients
  • Acute Stroke
  • Acute MI
  • Acute Asthma
  • Young fit individual for escalation to hospital
  • Patients whose functional/care needs cannot be managed safely at home

How to refer

Please call 01896 827722 and a clinician will speak to you there and then or call you back

Primary care management

Patients should have been assessed by someone from primary care, ideally face to face, within 24hrs prior to referral; with a set of observations.

The patient should consent to staying at home.

If asking for oxygen please ask if the patient smokes, vapes or has an open fire that they must use (i.e. has no central heating) as these would be contraindications to home O2.

We will organise investigations as we will often get bloods, for example, more quickly.

We cannot provide care.

Editorial Information

Author(s): Dr Effie Dearden.

Author email(s): Effie.dearden@nhs.scot.