Table 3

 Summary of HaH approaches in COPD

Admission avoidanceEarly supported discharge
Direct GP referral to respiratory unit for assessmentHospital referral for admission
SettingOutpatient clinicA&E admissions unitReview of COPD inpatients
ScopeStandby service operating at least during normal working hoursNormal minimum includes review on the weekday following admission
Expected workloadHigh, difficult to predict, inappropriate referrals likelyBetween one fifth and one sixth of all COPD admissions depending on the hours of operation of the serviceOver one third of admissions for COPD
Proportion suitable for HaHApproximately two thirdsOne thirdOver one third
AdvantagesPopular with patients and GPsReduces hospital bed-daysAllows planned assessments and uses HaH resources economically
May abort some exacerbationsAllows period of clinical stability which increases eligibility for HaH
DisadvantagesMay generate unnecessary workRecruitment limited by hours of operationDoes not reduce admission rates
Not examined in randomised controlled trialsRequires large throughput of patients to be time efficient