The efficacy of telehealth support for the hospital in the home

McCusker1, E.P. Greenup2

1 Acute Care@Home, Metro South HHS, Melissa.mccusker@health.qld.gov.au

2 Clinical Excellence Division, Queensland Health, Phil.greenup@health.qld.gov.au

 

Hospital in the Home (HITH) provides care in a patient’s residence for conditions requiring clinical governance, monitoring and/or input that would otherwise require treatment in an admitted hospital setting.  Transferring admitted patients early into HITH is popular in many health jurisdictions including Queensland based on evidence that patients have better or equal health outcomes, increased patient and carer satisfaction and reduced expenditure relating to service provision compared to patients remaining in hospital.  Improvements in technology have enabled the provision of treatment in the home at comparable levels of care to those experienced in hospital settings with the promise of increasingly complex and varied cases supported in the home in the future.

Conditions commonly treated by the HITH model include Cellulitis, Pulmonary Embolism, Urinary Tract Infection, Respiratory Infection and Venous Thrombosis.  Patients receive daily contact from registered nurses trained to perform Criteria Led Discharge (CLD) when appropriate for patients with few complications.  Patients unsuited to CLD require the review of a medial officer before being discharged from the program which traditionally involves a doctor visiting the patient’s home or the patient attending hospital a HITH clinic.

An evaluation of equipping nurses with mobile videoconferencing functionality sought to determine if such technology can reduce the frequency in which doctor or patient travel is required prior to discharge from HITH.  Also relevant was whether clinical standards of care can be maintained when doctors provide treatment advice or discharge patients during a video consultation compared the current practice of a physical assessment.  Rates of readmission after 28 days were used as a surrogate measure of clinical appropriateness.  Results of the evaluation indicate doctor travel time and associated costs were reduced while readmission rates between patients discharged in person or via Telehealth remained consistent.