The below criteria were used to assess eligibility:- |
Pneumonia—community acquired (CAP) or hospital acquired (HAP) | Acute exacerbations of COPD—infective & non-infective (other services already provided) |
Acute tracheo-bronchitis & acute bronchitis |
Non-pneumonic LTRI |
Infective exacerbation of asthma |
Infective exacerbation of bronchiectasis |
Lung abscess |
Pneumonia with concomitant COPD (if this service is not provided elsewhere) |
The below criteria were used to assess suitability:- |
Simple pleural effusions only (ideally a diagnostic pleural tap is performed in all cases) | Patients with CURB-65 >3 (MUST be discussed with the study doctor prior to discharge to define treatment ceilings and future plans) |
Can manage ADLs with current support—immediate OT/physio/social assessment/care can be arranged prior to discharge (if needed) and continued at home | Patients unable to manage at home even with maximal support from ESDS (this may include some patients IV drug users, with ETOH excess or mental health problems) |
Has a phone | Serious co-morbidities requiring hospital treatment (eg, CKD, CCF) or deemed unstable (significant AKD) |
Age>18 yrs old | Neutropenia |
Improving inflammatory markers (WCC/CRP) | Empyema or complicated parapneumonic effusion |
Stable or improving U&Es | Sats <92% on air (unless patient has underlying respiratory disease [except asthma] when sats<88% - all these cases MUST be discussed with study doctor) |
Pts requiring po or IV antibiotics | SBP<90 mm Hg |
Patients able to give fully informed consent (If patient unable to give fully informed consent—this will be obtained via NOK and 2 doctors) | Suspected MI/raised TnI consistent with NSTEMI OR acute ECG changes (within 5 days of discharge date) |
EWS ≤2 AND SBP>90 AND mild confusion only | Well enough for discharge without ESDS scheme support |
All observations must be stable for 12–24 h |
NB: If escalation of care not appropriate & palliative care appropriate if no improvement within 48 h: then criteria - stable SBP>90 AND sats>90% air AND phone AND >18 yrs old ONLY apply |
| Tuberculosis suspected |
| No fixed abode |