Hospital at Home A prototype model for home care provision

1. Hospital at HomeA prototype model for home care provision Dr. E. Papazissis MD MSc. Department of Hospital at Home HYGEIA Hospital Athens - Greece

2. The trend: Hospital Home

3. The evidence: “as safe as treatment in hospital”. Caplan et. al. MJA 1999 Patients“would use the service again if the opportunity arose”. Montalto M. Int J Qual Health Care 1996 Hospital in the home was significantly cheaper than in-hospital care, particular as a total episode substitution MacIntyre C. et. al. Int J Qual Health Care 2002

4. What is the very essence of a hospital? What is the element, without which it would not continue to be a hospital?

5. Hosp - doc Let’s imagine that we isolate: the doctors somewhere… The nurses elsewhere … … and the patients somewhere else …

6. Short distances ARE the key-point facilitating: • teamwork • observation • Rapid intervention • Diagnostic / therapeutic flow

7. If we move patients from hospital …

8. … to home environment …

9. L o n g d I s t a n c e HAH model How do we overcome this barrier? ICT L o n g d I s t a n c e

10. Nurses areNEARthe patients In a Hospital: In the Hospital at Home model: • Ward rounds • Ward rounds • Vital signs • Vital signs • Infusion rates • Infusion rates • medication • medication

11. In a Hospital: These facilities are unlikely to become available in the home evironment in the near future Patients areNEARmajor facilities In the Hospital at Home model: CT scan For these examinations patients should be transferred to hospital BUT MRI Nuclear Medicine They may return back to their homes As soon as the examinations are complete PET

12. In a Hospital: X-rays and encephalography are two examples of examinations which can be easily performed at home Patients areNEARminor facilities In the Hospital at Home model: Radiology Encephalography

13. In a Hospital: Doctors areNEARnurses In the Hospital at Home model: Care records Frontis application enables handling of the same patients’ care records by different care workers, at different places sumultaneously Instructions Doctors get quick information from nurses and nurses rapidly undertake and follow doctors’ instructions for implementation

14. In a Hospital: Doctors areNEARpatients In the Hospital at Home model: 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 Ward rounds • Ward rounds Emergency intervention Different spceialties Telemedicine facilities reduce the necessity of physical bedside presence of other specialists, who can contribute with their excellent expertise from a distance

15. Conclusion: Intelligent administrative structures telemedicine oriented ICT solution Canprovide at home high quality medical care to almost any patient who does not require surgery or ICU • safely • Efficiently • Costeffectively

16. What we need: More and carefully designed studies Addressing local needs and peculiarities In order to create robustevidence And establishstandards upon which POLICIES have to be based

17. Ireally appreciate your attention Ireally appreciate your attention

19. 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 hospitalfor emergencies • Proximity of the receiving hospital • Availability ofambulances • Local traffic conditions