The HSE's new 'Hospital in the Home' initiative, which allows suitable patients to be treated at home rather than in hospital, commenced in March. How successful has the consultant-led service been to date? Hélène Hofmanreports.
Three times a day for three weeks, Teresa Daly (56), an emphysema sufferer, was visited by a nurse at her home in Rathcoole, Co Dublin. The nurse carried out check-ups, necessary tests and administered her antibiotic. Every second day, she was visited by a doctor who checked on her progress.
Daly is one of 170 patients who has benefited from the HSE's new 'Hospital in the Home' (HITH) initiative. The new service, which allows suitable patients to be treated at home rather than in hospital, started in March.
"Every day they came to see me. They even came on Saturdays and Sundays when I needed them," says Daly, who was referred to the service by her GP. "They did the tests and everything. You can go to A&E and find yourself on a trolley for hours. There was no queue with this and everything was done in the comfort of my own home. And you're always better off at home."
The HITH service is provided by Tara Health on behalf of the HSE and is free of charge to patients regardless of their level of health insurance or GMS status. All users are admitted on a voluntary basis once they satisfy the inclusion criteria.
It's currently available to all patients attending the six acute hospitals in Dublin, which includes the five teaching hospitals and Connolly Hospital in Blanchardstown. Potential users can also be referred through an A&E department, through their GP if they are within the Dublin city and county catchment area, or may be transferred to the programme from a hospital ward once they've stabilised sufficiently.
"This is for people who don't need an acute bed, but still need a level of medical treatment. It is exactly what they'd receive in hospital but it is provided in the home and means that not only can we keep certain people from going into hospital but we can also discharge people earlier if they are suitable," says Bernadette Kiberd, the HSE's local health manager for the Dublin area.
A suitability assessment can be carried out at the hospital or, if the patient has been referred by their GP, they are taken to the Beacon Hospital in Sandyford to be tested, which takes about an hour and a half.
"This is part of the HSE's transformation and an attempt to move towards community-based care. The evidence shows that not only is it much nicer to be treated at home but the treatment time in those cases is shorter. Because it's consultant led, if anything changes then the person can be taken into hospital straight away," says Kiberd.
Once they have been accepted to the scheme, a multidisciplinary team - which includes 35 full-time nurses and six doctors - agrees on a treatment plan which can include intravenous therapy, home medical and nursing visits, physiotherapy and phlebotomy.
Each nursing team has Advanced Cardiac Life Support (ACLS) accreditation, experience in intravenous cannulation and phlebotomy and is backed up 24 hours a day by a full-time medical team. If complications arise the doctor on call carries out an assessment and if the patient's condition is no longer treatable in the home, transport is organised and they are admitted to A&E.
HITH has the capacity to treat between 1,000 and 1,500 people over the next 12 months. Many of these will suffer from illnesses like Chronic Obstructive Pulmonary Disease (COPD), pneumonia, cellulitis, urinary or respiratory tract infections or be undergoing a course of rehydration.
The HITH model is based on similar services in operation in the USA, Canada and Australia. However, whereas most international models are nurse-led, the Irish programme differs in that it is consultant led.
"That is probably where other models have fallen short," says Chay Bowes, chief executive of Tara Health. "With nurse-led programmes patients have eventually had to be re-admitted because the nurse couldn't make the assessment. We've taken the best practice models, and improved on them by making our model consultant led so the physician can go into the home and make that assessment.
"The feedback from everyone - GPs, patients, family - has been very positive. Patient satisfaction is running at just under 100 per cent, with almost all saying they'd rather be treated at home. It makes sense. You don't want to be in hospital if you can do your own thing at home, and watch EastEnders on your television while someone comes to take care of you," he says.
According to Bowes, the advantages of HITH is that it removes the risk of catching hospital-acquired infections, there are no queues and in most cases the treatment time is reduced. For example, he says, the average hospital stay for a patient with COPD is 12.5 days. When the care is transferred to the home it is reduced to eight days.
"That means we've saved 1,400 bed days at least so far," he says. "This is an innovative model and a genuine alternative to the hospital and one that is an important departure in health services," says Bowes.
HITH is currently only available in the Dublin area. However, the HSE is monitoring the success of the service and hopes to extend it to other areas.