Preventing avoidable admissions

Background

Westminster has the highest number of rough sleepers in England and, in response to this there are a number of specialist health interventions including two, specialist GP practices. GPs provide regular outreach sessions alongside the rough sleeping outreach team taking healthcare to those who are not accessing it. The ICB and local authority commission a number of health beds within the supported accommodation pathway with accompanying nursing in-reach and clinical supervision to prevent avoidable admissions and discharge to the street.

Case study

Towards the end of a joint street outreach session the team came across H, being escorted from Victoria Train Station departure hall by security.

He appeared profoundly unwell, extremely pale and unable to stand The GP and street engagement team member introduced themselves and had a conversation about health and housing. Like most initial encounters he wasn’t giving much away, however he knew he was unwell not having taken his medication for some time.

He was found to have capacity and refused hospital admission at this time. He was taken by taxi to an emergency hotel bed space where he was met in the morning by a street engagement worker, had a cooked breakfast and escorted to the surgery.

Later the next day he presented at the surgery five minutes before closing. He looked very unwell, had no shoes on and was not appropriately dressed for the season. The reception team brought him in from the cold and started the registration process. He was initially very reluctant to provide his details; with a bit of encouragement and explaining, he provided his details, enabling the GP to access to his medical history. He had been rough sleeping for the past 3 months, had been seen in A&E a few days before, receiving IV antibiotics and then discharged back on the streets with oral antibiotics, which he had yet to start. The GP noted there was considerably swelling on both his lower legs, cracked skin likely to be dependent oedema, which would worsen on the street. It was agreed that he was suitable for a local authority commissioned health bed and one was found 3 minutes’ walk from the surgery.

He returned the next day and had a thorough health check and reviewed on GP in-reach visit at the hostel two weeks later. Further bloods were taken and a diagnosis of myxoedema, severe hypothyroidism, with significantly raised TSH levels. To avoid admission duty GP spoke with a consultant at Guys and he was commenced on medication.

He improved over the next few weeks and the joined up work avoided an acute admission.

However, during his stay his past caught up with him and he was taken into custody for an offence that he had been avoiding for almost 8 years. He served a short time on remand and received a suspended sentence. Since that time he has turned his life around, he no longer worries about his past catching up with him, he is in good health and his social needs are currently being met and he is looking for employment.