Introduction The British Thoracic Society states that services for people with bronchiectasis should include the provision of home intravenous antibiotic therapy for exacerbations in selected patients.¹ This fits with the National objective of managing patients in the community. This should result in financial gains and improved patient outcomes. Our ‘Acute Hospital at Home’ (AHAH) service, is managed by a multidisciplinary team including Medical Consultants, Microbiologists, Nurses and Physiotherapists. There is regular Consultant review of patients via virtual ward rounds, and patients can be visited at home if required. Our service has the added benefit of home physiotherapy to reinforce the active cycle of breathing and we offer the facility to insert PICC lines and use surefusers. Our aim was to demonstrate the benefits of managing patients with infective exacerbations of bronchiectasis in the community.

Method We performed a retrospective analysis of 51 patient records. We looked at a number of clinical outcomes including length of stay, infection rates, culture rates and potential cost implications.

Results Patients managed through AHAH had shorter lengths of inpatient stays; 2.5 days compared to 9.1. The cost of an AHAH bed is £100/day and an acute medical bed is £280/day which Results in a saving of £1140 per patient per admission. Patients managed in the community were more likely to have their sputum cultured in accordance with BTS guidelines. We proved equivalence in rates of hospital acquired infections, readmissions and death. Patient satisfaction was significantly better in those managed in the community, 98% would recommend the service to family or friends compared to 83% of patients managed on an inpatient ward.

Conclusion Our Results demonstrate clear benefits of managing patients with exacerbations of bronchiectasis in the community, not only in terms of a reduction in hospital bed days and cost but also improved patient satisfaction. We believe that our AHAH service is a safe and beneficial clinical service which could be applied to other clinical conditions.

Reference

1. Quality Standards for Clinically Significant Bronchiectasis in Adults. British Thoracic Society2012;4(1).