This U.K. team brings hospital care into homes. Could more of these programs help Canada?

Health care teams in the UK are providing hospital-quality care to people at home to help ease the system facing a shortage of hospital beds. And while a version of the program exists in Canada, some experts say we need more to help address the health care system’s bottlenecks.

Hospital care at home is designed to look like a visit to a real hospital, rather than other community medicine such as long-term care. It can include ultrasounds, blood tests and IV treatments, sometimes checking a list of services that may take several separate hospitals.

Patients can receive one-time visits to assess their condition, or receive regular visits that equate to staying in the hospital for days or weeks.

“Why do you make a hospital or a house? [and] get it all or stay home [and] nothing,” said Dr. Dan Lasserson, clinical lead for the Acute Hospital at Home program in the UK White Coat, Black Art Dr. Brian Goldman.

In February, Goldman accompanied Lasserson and his team on a visit to a long-term care home in Thame, east of Oxford. He was there to see a patient, Joan Baxter, who was 88 years old.

Baxter had been in the hospital for several weeks before the fall, but was later allowed to go home. She was referred to Lasserson’s team for a check-up after she told her GP she wasn’t feeling well.

Davinia Newell, a team member and nurse working on her master’s degree, applied the gel to a miniature ultrasound probe, then pressed it into Baxter’s stomach. Images of the abdomen, then the heart and lungs appeared on Newell’s smartphone.

“My stomach is probably the most exposed stomach,” Baxter said with a laugh.

After consulting the results and asking a few follow-up questions, Lasserson and Newell decided Baxter could continue to stay at home for now.

“We did a very thorough assessment with him. Do point of care, ultrasound, blood, blood culture, urine,” said Newell.

“We deliver everything at home,” he said, except for some procedures such as X-rays.

‘He was always given a choice’

Most of the time, Lasserson and his team are on the road. Otherwise, he works at home at the John Radcliffe Hospital in Oxford.

There, they regularly review the patient’s medical profile in detail: medications, test results, blood pressure, and determine whether they need treatment or continued monitoring.

They receive about two or three referrals a day from emergency doctors, GPs, paramedics, concerned relatives and patients who have been treated at home and ask to be seen again.

The average age of the patients he sees is about 75, but the range is from 16 to 105, Lasserson said. Many, like Baxter, are in long-term care homes, but others live in their own homes or are supported by family or carers.

“They’re always given a choice, so home hospital is never forced on anyone,” Lasserson said.

“I have to say, you know, 999 times out of 1,000 people, people choose home.”

The program also helps keep costs down, he said, because staying at home reduces the health care system’s “hotel costs” for hospital stays — including meals.

Study in England 2021 found that hospital care at home “is a cost-effective alternative to hospital admission for selected elderly people,” with no difference in quality of care between patients at home or hospital.

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Growing interest in BC

Home hospital programs have been launched with successful results in Alberta and BC, but there is no commitment elsewhere in the country, according to a February article in the Canadian Medical Association Journal.

Supporters say it could help Canada’s health care system, which has been under enormous pressure since the pandemic, including staff and bed shortages and longer wait times for procedures from joint replacements to cancer surgery.

The BC program was launched in late 2020, operating out of Victoria General Hospital, in response to COVID-19. It has since expanded to the Royal Jubilee Hospital, also in Victoria. Sean Spina, regional clinical pharmacy manager at Island Health, said he serves the equivalent of a 20-bed ward through home visits.

In BC, the patient must go to the hospital first. If the condition does not require a longer hospitalization but still requires regular care, they can complete the treatment at home.

Similar to the English program team, the BC program’s multidisciplinary team includes occupational therapists, pharmacists, dieticians, nursing educators and others, said Dr. Nancy Humber, the program’s physician lead.

Humber said that by the end of February, the program had treated 1,391 patients, the equivalent of 10,000 hospital days. Many, though not all, patients are elderly, not unlike Lasserson’s patients.

“We try to take geriatric patients right out of the emergency room, because our program really allows them to have more care at home,” Humber said.

“We also know that there is a reduced 30-day readmission rate. And because of that, I think it’s appropriate for that population.”

‘Battle up the hill’

The oldest home hospital program may be in Australia, which has been part of the health care system for about 30 years, said Dr. Elisabeth Crisci, a doctor who supported, and led the first hospital in BC. home program when opened.

But Crisci said it “has been an uphill battle” in Canada to convince policymakers to invest more in the model.

“There’s still a sense that in Canada, unfortunately, our system is divided into these two silos,” he said. “Acute care includes in-hospital, [and] public concern is in the public.”

Crisci worries that since the pandemic measures have been stopped, the program may be neglected. He is also critical that the BC program requires patients to be admitted to the hospital first.

“The program … in Island Health has quickly become an enhanced discharge service and not one of hospital-prevention, which should be the whole point,” she said.

BC’s “prototype program” for hospital care at home has brought “significant benefits” to patients and caregivers, the province’s Ministry of Health said. White Coat, Black Art in the email statement.

It said more than 1,850 patients at Island Health and Northern Health units have received care at home instead of in hospital since the program was launched. He said he was “exploring options for potential expansion” of the program, but did not have a timeline for when this could happen.

Lasserson said he’s also heard “a lot of corridor trash talk” from skeptics who don’t think the program is sustainable. He says he invites his colleagues to look at the data and talk about potential solutions and improvements instead of writing.

“How do we tell people what we do, the way we do it? It’s difficult to write a paper about this stuff. Many have experience, see and understand what’s happening,” he said.