“Hospital in the Home”? What an odd concept. There are hospitals and there are homes – so how can you have a Hospital in the Home?
It sounds utterly absurd. Yet Hospital in the Home (or “HITH” for short) is indeed a reality and a growing one at that. As hospitals struggle to cope with the increasing demand on beds from growing and ageing populations, HITH can provide relief to both health services and patients.
So who is HITH for?
There are a number of patients in hospital who are physically well enough to be at home but still require hospital-standard therapy. One example of this is septic arthritis – a bacterial infection of the joints. In the beginning, patients with this condition are very sick and will need to come into hospital for surgery. Then will follow a period of weeks of intravenous (IV) antibiotics.
Usually within a few days of surgery, the patient feels much better and only remains in hospital to receive the IV antibiotics. They are otherwise quite well in themselves: their blood pressure, pulse rate and oxygen levels are fine and they have no more fevers. The HITH service provides such patients the opportunity to go home for their IV antibiotics.
What’s the next step?
Once a doctor feels that the patient can have IV antibiotics through HITH, a referral will be made to the HITH nurses. They will come to the ward and assess the patient to confirm that they are medically suitable for HITH. In addition, they have to make sure that the patient’s home situation is also appropriate.
This involves a number of practical considerations for the safety of both the patient and the nurses who will visit them at home e.g. is there a friend or relative who’ll be at home with the patient, can the patient go to the toilet unassisted, are there dangerous pets in the house etc? Also, the patient can’t live too far away from the hospital since the nurse has to drive there.
The patient goes home
If the HITH nurses are satisfied with the assessment, then the patient is sent home. Usually, the patients are officially still hospital patients admitted under a specialist even though they are physically at home. Instead of being patients on the Medical Ward or Surgical Ward, they are officially in the “Home Ward”. Then the nurses will visit them at home everyday to administer the antibiotics and check their vital observations (pulse, blood pressure, temperature, oxygen levels).
The nurses can even take blood if requested by the medical team. The doctors can either visit the patient at home to monitor their progress or alternatively, the patient can return to hospital to see the medical team as often as required.
Are these patients confined
to the house?
Not necessarily. Patients will often undertake short walks to the local shops, drive for short distances or even return to work. But most of them will need to rest at home.
How many times a day can a HITH nurse visit a patient at home?
This depends on the resources available to the HITH service. For example, in Canberra, HITH nurses can visit a patient up to twice a day at home. Furthermore, the nurses are on call 24 hours a day, 7 days a week. This means that patients can contact a nurse at anytime if they have any worries or concerns.
What if a HITH patient needs antibiotics more than twice a day? Can the nurses manage?
There are electronic pumps about the size of one’s hand into which the day’s supply of antibiotics can be placed. The pump can be programmed to give the antibiotics doses throughout the day as often as needed. Since the pump is quite small, the patient can wear it without it affecting their mobility. This means that a nurse only has to visit the patient once a day to change the antibiotics for the pump.
What are the advantages
of a HITH service?
The obvious advantage of a HITH service for patients is simply being at home. Surveys have confirmed that patients prefer home over hospital, which is not really surprising. The alternative is lying in a hospital bed less comfortable than your own, eating hospital food, possibly sharing a room (and a toilet) with other patients, unable to sleep because of the unfamiliar and noisy environment. Furthermore, patients at home are less likely to pick up the resistant bacteria that hang around hospitals.
From the hospital’s viewpoint, the ability to deliver hospital-standard care at home is very useful. In particular, it means that there are more beds in hospital available for really sick patients, thereby increasing good outcomes for patients and reducing complaints.
Can HITH be used to treat
many other conditions?
Yes, it can. Although the example of an infection was given above, a HITH service can be used to treat a number of non-infective conditions. Some examples are: anticoagulation for people with blood clots, rehydrating people with IV fluids, treating heart failure with IV diuretics or looking after patients who have just undergone surgery.
And of course, HITH can be used to treat a wide range of infections apart from the infected joint discussed previously. These include infections of the bones (osteomyelitis), the skin (cellulitis), heart valves (endocarditis), the blood (septicaemia), the throat and tonsils to name but a few.
Is there only one way
to design a HITH?
Not at all. The HITH model for a hospital will depend on patient needs and available resources. For example, there are HITH services that teach patients to administer their own injections while others only allow HITH nurses to do this.
So, as you may gather, a Sri Lankan HITH service would probably be quite different to an Australian one. In fact, the HITH service for a Sri Lankan government hospital would vary from that of a Sri Lankan private hospital.
Conclusion
HITH is a safe alternative to being treated in hospital that is advantageous to both patients and health care services alike. At the end of the day, patients would rather be treated at home than at hospital. It would be wonderful for both patients and hospitals if HITH services became widely available in Sri Lanka.
(The writer is Director of Hospital in the Home, Canberra Hospital and Consultant Physican in Infectious Diseases) |
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