Organisational implications of hospital admissions at home for hospitals
EP de Kluiver, J Boyne, W Bruins, HP Brunner-La Rocca, A Burdett, P Dendale, J Hughes, D Knoppel, M Lange, A Lillie, M. Scherrenberg, V Storms, J Vranken, AE van der Velde
Given the increased pressure on health care budgets, aging of the population, medical and technological developments, and the changed needs of patients, there is a clear necessity to modernise the health care system.
Up to 46 % of hospital might be provided at home. In the last years hospitals provided more ambulatory services at home. However, the delivery of hospital admissions at home is still in its infancy.
It is a wide spread paradigm that a hospital is the best place for patients. In fact, hospitals can be a harmful environment for patients, especially the elderly. Adverse events like delirium, hospital infections and fall incidents among admitted elderly patients are common. The vast majority of chronic heart failure patients is an elderly patient (≥ 65 years of age).
In 2005 Isala Heart Centre, The Netherlands, started a pilot for treating heart failure patients at home: Chance@Home. It was concluded that home-based administration of intravenous medication by specialised nurses was a feasible, effective, safe and patient friendly alternative for regular in-hospital care in patients with a known aetiology of high risk decompensated chronic heart failure. After this successful pilot, Chance@Home was offered as a regular service. Nowadays, more than 5000 patients were treated at home. Satisfaction of patients and professionals is high. Vulnerable patients benefit the most: no delirium was observed, the percentages of infections and fall incidents are low and patients are more active. Interestingly, a hospital admission at home costs on average 40% less than a regular hospital admission. By providing better outcomes against lower costs Chance@Home is a paragon of value-based health care.
With the societal urge for innovative solutions to cope with a rapidly increasing number of chronic (heart failure) patients, there is a need for upscaling and professionalising the Chance@Home initiative. Chance@Home is up to now a local initiative with the necessity to develop further into a fully mature service with the possibility of replication. Both organisational and technological innovation is needed for scale up.
NWE-Chance is an Interreg North-West Europe funded project conducted by a consortium of ten partners in three countries. Within NWE-Chance promising integrated eHealth applications will be developed for admitting heart failure patients at home and the feasibility of both technology and supporting care process will be tested by three hospitals. NWE-Chance will end with the launch of an innovation hub to bring stakeholders together and to share knowledge with respect to home hospitalisations.
From an organisational point of view a detailed description (blueprint) of the organisation is needed to provide a solid basis for other parties to elaborately implement a hospitalisation at home programme. Recently the first blueprint was delivered. It describes a full service home hospitalisation programme for heart failure patients. The blueprint describes the health care process, provides insights into the organisational model, logistic conditions and quality management. Furthermore, the technical environment is discussed. Last part of the blueprint is dedicated to standard (operating) procedures and work instructions.
Although the first blueprint focusses on a home hospitalisation programme for heart failure, general lessons valuable to other hospitals are learned. Main lessons learned so far: start with a well-defined patient pathway, but keep in mind that the service must be scalable; the patient is leading, not the technology; provide a 24/7 service.