Healthcare teams across the UK are providing hospital-grade care to people at home to help relieve systems facing a shortage of hospital beds. And while versions of these programs exist in Canada, some experts say we need more to help reduce the bottleneck in our own health care system.
Home hospital care is designed to be more like a visit to an actual hospital, rather than other community medicine such as long-term care. This can include ultrasounds, blood tests and intravenous treatments, sometimes ticking off a list of services that might otherwise require several separate hospital stays.
Patients could receive one-time visits to assess their condition or receive regular visits analogous to a hospital stay over several days or weeks.
“Why make the hospital or the home binary? You know, you either come to the hospital (and) take it all or stay home (and) get nothing,” said Dr Dan Lasserson, clinical manager of the Acute Hospital At Home program in the UK. White coat, black art Dr Brian Goldman.
In February, Goldman accompanied Lasserson and his team on a visit to a long-term care home in Thame, east of Oxford. They are there to see a patient, Joan Baxter, who is 88 years old.
Baxter had been admitted to hospital a few weeks earlier after falling, but was later allowed to return home. She was referred to Lasserson’s team for check-in after telling her GP she was not feeling well.
Davinia Newell, a member of the team and a nurse working on her master’s degree, applies gel to a miniature ultrasound probe, then presses it onto Baxter’s stomach. Images of his stomach, then his heart and lungs appear on Newell’s smartphone.
“My belly has got to be the most watched belly,” Baxter said with a chuckle.
After reviewing the results and asking a few follow-up questions, Lasserson and Newell decide Baxter can continue to stay home for the time being.
“We did a very thorough assessment with her. We did point of care, ultrasound, blood work, blood cultures, urine,” Newell said.
“We deliver everything to your home,” she explained, except for certain procedures such as x-rays.
“They always have a choice”
Most of the time, Lasserson and his team are on the road. When not, they work from their home base at John Radcliffe Hospital in Oxford.
There, they regularly review their patients’ medical profiles in great detail: medications, test results, blood pressure, and assess whether they need ongoing treatment or monitoring.
They receive around two or three referrals a day from emergency doctors, general practitioners, paramedics, concerned parents and patients who have been cared for at home and are asking to be seen again.
The average age of patients they see is around 75, but the range is 16 to 105, Lasserson said. Many, like Baxter, are in long-term care homes, but others live alone in their own homes or supported by family or caregivers.
“They always have a choice, so a home hospital is never forced on anyone,” Lasserson said.
“I have to say, you know, 999 times out of 1,000 people, people choose their house. »
The program also helps cut costs, he argues, because staying at home relieves the healthcare system of “hotel costs” associated with staying in hospital, including food.
A UK study from 2021 found that inpatient home care “provides a cost-effective alternative to hospital admission for some older people,” with little or no difference in the quality of care between inpatients and home patients.
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Growing interest in British Columbia
Hospital-at-home programs have been launched successfully in Alberta and British Columbia, but have seen little to no commitment elsewhere in the country, according to a February article in the Canadian Medical Association Journal.
Proponents said it could help Canada’s healthcare system, which has been under immense pressure since the pandemic, including staff and bed shortages and longer wait times for procedures ranging from joint replacements to cancer surgeries. .
The BC program was launched in late 2020, from Victoria General Hospital, in response to COVID-19. It has since been extended to the Royal Jubilee Hospital, also in Victoria. Sean Spina, regional clinical pharmacy manager at Island Health, says they serve the equivalent of a 20-bed ward during their home visits.
In British Columbia, patients must first be admitted to hospital. If their condition does not require longer hospitalization but they still require regular care, they can complete their treatment at home.
Similar to the UK program team, the BC program’s multidisciplinary team includes an occupational therapist, pharmacist, dietitian, nursing educator and more, said co-director Dr Nancy Humber. medical program.
Humber says that by the end of February, the program had treated 1,391 patients, for the equivalent of nearly 10,000 hospital days. Many, but not all, of the patients are in their old age, much like Lasserson’s patients.
“We try to get geriatric patients straight out of the emergency room because our program really allows them to have the rest of their care at home,” Humber said.
“We also know there is a reduced 30-day readmission rate. And because of that, I think it’s a good choice for this population. »
“A difficult battle”
The oldest hospital-at-home program may be Australia’s, where it’s been part of their healthcare system for around 30 years, said Dr Elisabeth Crisci, a doctor who championed and co-led Australia’s first hospital-at-home. British Columbia. host program when it was launched.
But Crisci says “it’s been an uphill battle” in Canada to convince policymakers to invest more in the model.
“There’s always a feeling that in Canada, unfortunately, our system is split into these two silos,” she said. “Acute care belongs to the hospital, (and) community care belongs to the community. »
Crisci fears that with the end of the pandemic measures, the program will also be neglected. She also insists that the BC program requires patients to be admitted to hospital first.
“The … Island Health program quickly became an enhanced discharge service and not a hospital avoidance service, which should be the whole point,” she said.
British Columbia’s ‘prototype programs’ for hospital home care have delivered ‘significant benefits’ to patients and caregivers, the province’s health ministry says White Coat, Black Art in an emailed statement.
He said more than 1,850 patients from Island Health and Northern Health units have received care at home rather than in hospital since the program began. He said he was “exploring options for potential expansion” of the program, but had no timetable for when that might happen.
Lasserson said he’s also heard “a lot of hallway talk” from skeptics who don’t think the program is sustainable. He says he invites his colleagues to review their data and discuss potential solutions and improvements instead of canceling it.
“How can we tell people what we do, how we do it? It’s hard to write articles about this stuff. It’s largely experiential, seeing it and getting a sense of what’s going on,” he said.
