Homeless Intermediate Care Pilot Project helps reduce hospital, ED admissions

A nurse outreach programme to treat people using a homeless shelter in London led to a fall of 77 per cent in hospital admissions from the shelter and a cut of 52 per cent in emergency department attendances.

Statistics show that people who are homeless in England attend emergency departments (EDs) five times more often than people who have a home and they are admitted to hospital three times as often.

As a result, a one-year pilot programme - the Homeless Intermediate Care Pilot Project - was set up at St Mungo's hostel in Clapham, south London.

It was staffed during the week by a clinical nurse specialist and a health support worker while a general practitioner worked at the hostel once a week for four and a half hours. A district nursing team took over at weekends.

Clinical interventions included comprehensive health assessments, daily monitoring of acute and chronic disease, vaccination, medication adherence checks and venepuncture. The health support worker also undertook non-clinical interventions such as escorting clients to appointments, and helping them find voluntary work and claim benefits.

During the trial, 34 clients were admitted onto the caseload with presenting conditions such as acute bacterial endocarditis, acute syphilis, end-stage liver failure, renal failure and pulmonary tuberculosis.

Writing in the journal Emergency Nurse, Kendra Schneller, clinical nurse specialist at Guy's and St Thomas's Foundation trust in London, compares data from St Mungo's with other hostels in the area, which did not show similar falls in hospital or ED admissions.

'Clients problems are identified early so their conditions can be managed by the project team in the community. Overall, the team demonstrates that homeless clients' health outcomes can be improved, while ambulance calls, ED attendance and re-admission rates can be reduced.'