Introduction Hospital at Home is defined as ‘an acute clinical service that takes staff, equipment, technologies, medication, and skills usually provided in hospitals and delivers that hospital care to selected people in their homes or in nursing homes’. Our hospital-at-home service has delivered 12617 clinical episodes for 9844 unique patients between January 2021 and November 2023, with training and capacity of the service increasing year-on-year. Innovative solutions such as point-of-care blood tests are already widely used, and we set out to explore additional digital technology which could enhance patient outcomes.

Aims and objectives of the research project or activity There is an opportunity to use Point of care ultrasound (POCUS) to further support assessments done within a patient’s home. POCUS has been shown to diagnose respiratory conditions such as pneumonia, pleural effusion and pneumothorax with no statistical difference in accuracy to the standard emergency department evaluation. It can also be used to diagnose deep vein thrombosis and assess fluid status in heart failure patients. We aimed to integrate POCUS within our multi-disciplinary Hospital at Home team capabilities, in order to support admission avoidance.

Method or approach Multidisciplinary staff members including doctors, nurses and a pharmacist were trained in Point-of-care ultrasound. The Society of Acute Medicine’s Focused Acute Medicine Ultrasound guidance was followed, with supervision from an accredited medical consultant. Theoretical training was provided through ‘eLearning For Health’ online modules. Practical proficiency was delivered through directly supervised scans (10 in total), with subsequent progression to unsupervised scans (40 in total). This provides a gradual transition towards independent practice. We also introduced ad-hoc discussions and weekly multidisciplinary team (MDT) virtual ward rounds to incorporate formal reviews of unsupervised scans by an accredited medical consultant.

Findings Ten members of staff within our department have started using POCUS as part of their clinical assessments within the patient’s home. They have conducted over 150 scans of patients within the last 6 months, with the majority of the scans being done for an accurate assessment of fluid status. Staff report that POCUS has provided rapid diagnostic benefits, with one case example of POCUS excluding post-renal obstruction in an acute kidney injury. It also reduces the conveyance of patients to hospital for ionising radiation and other diagnostics, and holds particular benefits for patients for whom a hospital visit may be risky due to nosocomial infection or disorientation. The use of weekly MDT virtual ward rounds was described as a key mechanism for fostering continuous improvement and consolidation of ultrasound knowledge across the MDT team. There are further plans to expand training to additional team members to increase scanning capacity.

Key messages Implementing POCUS as standard practice in Hospital at Home services can aid diagnosis and assessment, as well as support decision-making for avoidance of conveyance to hospital. We have illustrated the utilisation of POCUS contributing to patient care in over 150 patients, and have demonstrated that non-medical team members can also be trained. Furthermore, introducing this novel diagnostic skill has aligned with our team’s broader focus to create more patient-centred and efficient services. A further analysis into the potential cost savings from the utilisation of POCUS in reducing time to diagnosis and possible subsequent hospital admission could be considered.