Hospital at Home

• Hospital at Home will first launch through the University Hospital of Northern BC (UHNBC) in Prince George with additional sites being determined later.

• The UHNBC Hospital at Home (H@H) inpatient unit did a ‘soft’ launch on March 15, 2021 for an eight-week prototyping phase.
• For the prototype phase of Hospital at Home, we focused on the following patient specific complex medical populations:
  • Patients already receiving community-based palliative care services who temporarily require acute-level care (i.e., for a pain crisis, uncontrolled symptoms, congestive heart failure).
  • Patients who require enhanced IV therapy that extends beyond regular services to allow time for adjustments to medication routine that will fit within regular extended hours services.
  • Specific post-surgical patients who require 24 hour care following surgery (i.e., Laparoscopic Assisted Vagina Hysterectomy).
• During this time, the team successfully admitted, cared for and discharged 36 patients, the majority of which were in the medicine service and a few under the surgical service.
• Between 1/4 – 1/3 were palliative care patients (mainly IV antibiotics). The top 10 admitting diagnoses included:
  • Cholecystitis
  • Dehydration
  • Diverticulitis
  • Esophageal Mass
  • Laparoscopic Assisted Vaginal Hysterectomy
  • Myomectomy
  • Pancreatitis
  • Pneumonia
  • Pulmonary Embolism
  • Urosepsis
• Patients and their families provided overwhelming positive feedback about their experience.
• Barriers to admission included: no caregiver for patient support and safety, patients identified from long-term care and assisted living, and patients who had medical conditions not included in the admission criteria. An additional positive impact was that 12 patients were identified as being appropriate for discharge from acute care.

• Agreement needs to be reached provincially as to how to compensate fee-for-service primary care physicians rending H@H services to support longitudinal comprehensive care of patients.
• While this issue is being resolved provincially, the Prince George H@H service will continue to operate by admitting post-operative patients appropriate to this level of care, beginning with gynecological surgeries, with the surgeon taking on the role as MRP.
• Once a suitable primary care compensation model has been determined, the service will move to admit stable medical patients under their primary care provider.

• Patient eligibility is assessed against defined demographic and clinical characteristics. This includes basic criteria such as:
  • Do they have a known diagnosis, and are they clinically stable?
  • Are they unlikely to require multiple in-hospital tests, treatments or consultations?
  • Do they have a safe home environment and a caregiver in the home?
  • Do they live close to the hospital?
• Patients and caregivers must provide informed consent for admission to the program. Admitting physicians are expected to consider any other relevant factor(s) that may affect the patient’s likelihood of doing well in the Hospital at Home program.
• When determining whether someone is eligible for the program, their health and safety is always of the utmost importance.

Programs similar to Hospital at Home have been used in other jurisdictions worldwide, where they have been shown to improve patients’ and families’ experiences of care.

• Many research studies have shown that this type of program provides the same or better care than traditional inpatient hospitalization, including three Cochrane medical reviews, which represent the highest standard in evidence-based health care research.
• A hospital stay can sometimes pose physical, cultural, financial or psychological barriers to accessing care that, for some, can be reduced by being at home.
• Receiving care at home can help minimize disruption to relationships with family, caregivers, and community, as well as disruption to other important parts of day-to-day life such as diet, sleep, and hobbies.
• Hospital at Home can reduce risks to patients associated with time spent in hospital, such as infection and decline in function, cognition/delirium, and changes to mental health.
• By providing short-term acute care in the patient’s home, the program will improve access and increase efficiency. It will do this by reducing pressure on in-patient hospital beds, decreasing hospital congestion by optimizing patient flow, and improving overall system capacity.

• If at any time a patient’s condition deteriorates at home, the program allows for their immediate transfer into hospital (bypassing the Emergency Department).
• Hospital at Home will have systems and processes in place to quickly recognize, respond to, and escalate care for deteriorating patients.

Agreement needs to be reached provincially as to how to compensate fee-for-service primary care physicians rending H@H services to support longitudinal comprehensive care of patients.

• There are many examples of programs similar to Hospital at Home around the world:
  • In Australia, the first Hospital in the Home program was introduced at the state level in 1994.
  • John Hopkins Hospital in the United States introduced their Hospital at Home program in 1995.
  • The Australian state of Victoria is currently running their program with about 500 ‘virtual’ hospital beds in 52 services sites across the states.
  • The program has been very well received by both health-care professionals and the public and is heavily used in both the United States, particularly in veteran’s hospitals, and Australia.
  • Scotland is also working to expand its existing programs, and the National Health Service in England also offers some Hospital at Home programs.
  • A pilot Hospital at Home program was offered in Toronto; we have incorporated lessons from that experience to the BC prototype. 
  • Alberta also has a program called Hospital at Home; however, that program is quite different from the BC approach.