| Project Objectives / Summary:
Hospital in the home involves the provision of acute care interventions to the patient in their place of residence.
HIYH had six core objectives:
- To provide comprehensive acute care by a clinical team lead by a GP - with care being clinically equivalent to hospital in-patient care;
- To maintain patients in their own homes;
- To increase the acute care skills of nurses and target specific up-skilling for GPs;
- To ensure effective communication networks between GPs, community services and allied health services;
- To provide cost effective health care to the community of Katanning; and
- To provide an effective alternative to hospital admission to Katanning Health Service.
Project Collaboration:
The project involved the allied health services located within the township of Katanning. All GPs practicing in Katanning during the project duration were involved in the project. The project was in collaboration with the staff and management of the Katanning Area Health Service.
Project Outcomes:
The Katanning Hospital in Your Home (HIYH) pilot program was a successful one in a small and culturally diverse community. The HIYH project achieved all core objectives.
The HIYH program catered for over 120 patients over the period. Given the population mix in Katanning, the Division considers HIYH can cater for different cultural needs.
The program involved all Katanning based GPs, Registered Nurses (recruited from outside the town due to shortages) and allied health personnel, where necessary. The nursing shortage is a major issue and the need to recruit from elsewhere added to costs.
Overall, there were high satisfaction levels with the program from patients, GPs and others involved. Particular benefits were seen in a reduced length of stay and patient comfort with the home-based care.
Recommendations:
- Hospital Based
- To be considered as another "ward" of the hospital with a designated team of nurses with a strong grounding in acute nursing. Within a hospital there would be better access to staff education, resources and ongoing maintenance, and updating of clinical skills and skilled staff for relief cover;
- Use of established policies, protocols and clinical pathways;
- Integration of patient medical records;
- Ease of access to equipment and consumables from hospital stores; and Access to after-hours interim medications and to cater for those patients who cannot afford medications, which is a barrier to admissions and therefore, affects equity of access.
- GPs as Case Manager central to Patient Care
- Address difficulties associated with GP home visits to ensure that the patient receives the required frequency of medical consultation. Consideration given to scheduling home visits into the daily routine as for hospital inpatients;
- Consider Practice-based visits for consultations with the GP if the patient agrees. Should this be adopted, then a system is required to ensure appointments can be obtained within the necessary time-frame;
- Establish a protocol for telephoning GPs that meets the needs of all parties (GP, RN, patients and carers); and
- GPs and GSDGP to continue to be key stakeholders in HITH programs.
- Explore medical technology and pharmacology to enhance patient care and to increase the variety and acuity of patients eligible for admission.
- Consider a larger catchment area than 10km from the township.
- Extended length of stay to be evaluated on an individual basis with a policy that allows unnecessary transfer to hospital, but does not allow for delayed discharge.
- Allow for an overnight stay in hospital accommodating the required home assessment during daylight hours.
- Continue the development of culturally appropriate program promotion and patient information.
- Expand Evaluation and Improve Methodology
- Patient survey to be more culturally and linguistically appropriate;
- A more inclusive and detailed survey of carers;
- Patient and carer/family psychosocial and economic evaluation to be expanded; and
- Evaluation of patients who did not wish to be admitted onto the Program to determine barriers to admission.
Disseminating Project Information:
Production and dissemination of Hospital in Your Home brochure.
Production and dissemination of Patient Handbook for HIYH participants.
Production and dissemination of Information booklets for Patients and Carers. Topics included pneumonia, cellulitis, deep vein thrombosis (DVT), and Pyelonephritis (kidney infection).
Production and dissemination of GP Resource Kit and Patient Information Pack.
Lessons / Assessment:
Earlier work in WA has shown that Hospital in the Home is a workable proposition in urban areas. This project sought to examine how this would work in a rural setting.
Clearly, the issues of GP and Nurse availability remain crucial ones. The project demonstrates that HIYH can and does produce worthwhile results but workforce issues add to costs.
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