Table 1 Selection criteria

Patient eligibility

Patients with any of the following conditions:

• Pneumonia – CAP or HAP [radiological consolidation and symptoms/signs of respiratory infection] N.B. if CURB-65 ≥ 3 MUST have had at least 24hrs of in-patient observation before recruitment.

• Non-pneumonic lower respiratory tract infection [No radiological consolidation but symptoms/signs of respiratory infection]

• Pneumonia with concomitant COPD (if this service is not provided elsewhere)

Inclusion criteria

Features on history

• Patient able to give fully informed consent

• Has a phone

• Age > 18yrs old

Features on examination (stability indicator)

• Early warning score ≤2 (EWS, a score calculated using baseline observations) AND SBP > 90 AND mild confusion only (Abbreviated mini-mental test score [AMTS] ≥ 7). All observations must be stable for 12-24hrs

• Stable/improving inflammatory markers (WCC/CRP)

• Stable/improving U&Es

Features of social situation

• Can manage ADLs with current support (immediate OT/physiotherapy/social care can be arranged)

Exclusion criteria

Features on history

• Well enough for discharge without home care support

• No fixed abode

Features on examination (instability indicator)

• SBP < 90 mmHg

• For patients with chronic respiratory illness: saturations <88% on air [except asthma]

• For patients without chronic respiratory illness: saturations <92% on air

Features of diagnosis (indicating cause for concern)

• Suspected MI/raised TnI/T consistent with NSTEMI within 5 days of discharge

• Empyema or complicated parapneumonic effusion

• Tuberculosis suspected

• Neutropenia

• Acute exacerbations of COPD – infective & non-infective (other services are already provided)

• Serious co-morbidities requiring hospital treatment (e.g: CKD, CCF) or deemed unstable (significant AKD)

Features of social situation

• Patients unable to manage at home even with maximal support (e.g. IV drug users, alcohol excess or mental health problems)