Hospital at HomeA prototype model for home care provision

Dr. E. Papazissis MD MSc.

Department of Hospital at Home

HYGEIA Hospital

Athens - Greece

Hospital Home

The trend:

“as safe as treatment in hospital”.

Montalto M.

Caplan et. al. MJA 1999

Patients“would use the service again if the opportunity arose”.

Int J Qual Health Care 1996

The evidence:

MacIntyre C. et. al.

Hospital in the home was significantly cheaper than in-hospital care, particular as a total episode substitution

Int J Qual Health Care 2002

What is the very essence of a hospital?

What is the element, without which it would not continue to be a hospital?

Hosp - doc

Let’s imagine that we isolate:

the doctors somewhere…The nurses elsewhere …… and the patients somewhere else …

Short distances

•teamwork •observation

•Diagnostic / therapeutic flow •Rapid intervention

AREfacilitating:

the key-point

If we move patients from

hospital …

… to home environment …

How do we

overcome

this barrier?

HAH model

ICT

L o n g d I s t a n c e

L o n g d I s t a n c e

Nurses are NEAR the patients

•Ward rounds

•medication

•Infusion rates

•Vital signs

In a Hospital:

•Ward rounds

•Vital signs

•Infusion rates

•medication

In the Hospital at Home model:

These facilities are unlikely to

become available

in the home evironment

in the near future

CT scan

PET

Nuclear Medicine

MRI

They may return back to their homes

As soon as the examinations are complete

For these examinations patients should be transferred to hospital

BUT

Patients are NEAR major facilitiesIn a Hospital:

In the Hospital at Home model:

Radiology

Encephalography

Patients are NEAR minor facilitiesIn a Hospital:

In the Hospital at Home model:

X-rays and encephalography

are two examples of

examinations which can be

easily performed at home

Care records

Instructions

Doctors are NEAR nursesIn a Hospital:

Frontis application enables handling of the same patients’ care records by different care workers, at different places sumultaneously

Doctors get quick information from nurses and nurses rapidly undertake and follow doctors’ instructions for implementation

In the Hospital at Home model:

Ward rounds

Different spceialties

Emergency intervention

Doctors are NEAR patientsIn a Hospital:

In the Hospital at Home model:

•Ward rounds

Telemedicine facilities reduce the necessity of physical bedside presence of other specialists, who can contribute with their excellent expertise from a distance

All of our medical and nursing teams are trained,

experienced and properly equipped to be able to

act at the site of the crisis and provide aid

exactly as they would do in the emergency

department of a hospital

Conclusion:Intelligent administrative structures

telemedicine oriented ICT solution

Can provide at home high quality medical care

who does not require

to almost any patient

surgery or ICU

•safely

•Efficiently

•Cost effectively

What we need:

upon which POLICIES have to be based

More and carefully designed studies

In order to create robust evidence

Addressing local needs and peculiarities

And establish standards

I really appreciat

e your attention

I really appreciat

e your attention

Factors to be considered for offering Hospital at Home care:

•Likelihood of life-threatening complications•Dependency of possible complications to ICU or surgery•Degree of monitoring / delay of complication alerts•Time interval for efficient intervention

•Readiness of hospital at home /Maximum time of response•Efficiency to act at the site of crisis

•Readiness of the receiving hospital for emergencies

•Proximity of the receiving hospital

•Availability of ambulances

•Local traffic conditions