HOME FIRST Pilot: a Study of Early Supported Discharge in Patients With Lower Respiratory Tract Infections (HOMEFIRST)
Community Acquired Pneumonia, Hospital Acquired Pneumonia, Lower Respiratory Tract Infection
About this trial
This is an interventional supportive care trial for Community Acquired Pneumonia focused on measuring Pneumonia, Community, Hospital, Respiratory, Infection
Eligibility Criteria
Eligibility - Patients with any of the following conditions;
- Pneumonia - community-acquired (CAP) or hospital-acquired (HAP) - pneumonia definition - a series of clinical symptoms with radiological consolidation N.B. All pneumonia CURB-65 scores will be considered but patients with CURB-65 ≥3 MUST have had at least 24hrs of in-patient observation before recruitment into part B of the study.
- Pneumonia with concomitant COPD or bronchiectasis
- Non-pneumonic lower respiratory tract infection without COPD or bronchiectasis
Inclusion Criteria:
- Age>18yrs old
- All observations must be stable for 12-24hrs
- EWS ≤2 AND SBP>90 (all observations must be stable for 12-24hrs)
- Has a telephone
- Can manage activities of daily living with current available support (If needed, immediate occupational therapy/physiotherapy/social assessment and care can be arranged prior to discharge and continued at home)
- Improving/stable inflammatory markers
- Improving/stable U&Es
- Fluent English speaker
Exclusion Criteria;
- Acute exacerbations of COPD
- Acute exacerbations of bronchiectasis without consolidation
- Patients with CURB-65 >3 admitted <24 hours ago
- Patients unable to manage at home even with maximal support from HOME FIRST (This may include intravenous drug users, patients with history of excess alcohol consumption or mental health problems)
- Empyema or untapped pleural effusion (If no diagnostic pleural tap performed - discuss with study doctor)
- Serious co-morbidities requiring hospital treatment (e.g. CKD, CCF) or deemed unstable (significant AKD)
- Suspected MI/raised TnI/T consistent with NSTEMI (Or acute ECG changes) within 5 days of discharge
- Empyema or complicated parapneumonic effusion
- SBP<90mmHg
- Neutropenia
- No fixed abode
- Tuberculosis suspected
- Well enough for discharge without HOME FIRST support
- Oxygen saturations <92% on air - for patients without chronic respiratory illness Oxygen saturations <88% on air - for patients with chronic respiratory illness (excluding asthma for which oxygen saturations must be >92% on air). All such cases MUST be discussed as oxygen assessment may be needed
Sites / Locations
- Royal Liverpool And Broadgreen University Hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Standard Hospital Care (SHC)
HOMEFIRST
All management and discharge decisions will be made by the patient's usual hospital team. Clinical tests will be performed at the discretion of the medical team. If any significant or concerning clinical issues are noted during study team's visits, the usual medical team will be alerted. Patients receiving SHC will be discussed at weekly case note MDT meeting and followed-up on discharge in the 'Respiratory Infection' out-patient clinic (in the patient's own home if necessary) at 6 weeks, with a repeat chest X-ray if needed.
Patients randomised to HOMEFIRST care will initially receive up to twice daily visits for the first 48 hours. After this, the frequency and duration of visits will depend on clinical need but not exceed 5 days. The study nurse will establish the need for the involvement of other MDT members. Laboratory tests will be performed as clinically indicated. Venepuncture will be performed for clinical purposes as needed. Patients will be discussed at a weekly case-note MDT meeting and followed-up on discharge in the 'Respiratory Infection' out-patient clinic (in the patient's own home if necessary) at 6 weeks, with a repeat chest X-ray if needed. Patients are either discharged from HOMEFIRST, readmitted or handed over to their community care team at the end of the intervention.