Island Health succeeds with Hospital at Home

When COVID-19 became a fact of life, healthcare organizations had to adapt quickly in order to best serve their communities. However, Island Health on Vancouver Island, BC, had already started thinking beyond the hospital walls ahead of the onset of the pandemic with what would become its lauded Hospital at Home program.

As Dr Sean Spina, director of special projects at Island Health recounts, “In mid-2019… we were looking at ways of doing healthcare better. Our hospitals are challenged by capacity, and we were aware of some of these programs in other areas around the world called Hospital at Home”.

With over 150 facilities serving more than 860,000 people across Vancouver Island and surrounding communities, the project would not be a simple one, even with similar systems operating elsewhere. As Dr Spina notes, before beginning, it was vital to consider “Canadian patients, the Canadian healthcare system, Canadian physicians, and Canadian priorities”.

The basis of the program remains – provide eligible patients the choice to receive short-term care in their own home, with regular visits from a multidisciplinary team, and family members being able to act as caregivers to assist with day-to-day needs, after they have received sufficient training.

Safety and communication are essential

Taking patients out of the typical healthcare environment could raise questions about the care provided, but this was considered from the start. Dr Spina confirms, “We built and initiated the program with the lens of patient safety. We initiated it during the first months of the pandemic, and one of the focuses was safety, safety, safety”.

As the program progressed, the Island Health team discovered that patient experience and outcomes improved in the home setting, with Dr Spina commenting, “What we've heard through our journey is that many times patients say, ‘I have a reason to wake up and put my lipstick on in the morning because the doctor is coming at 10 o'clock’; even though they're acutely ill, they actually recover faster because they're at home”.

Going hand in hand with patient safety is secure communications, which is where collaboration with Oracle Cerner came in. As noted by Robyn Candell, nurse informaticist at Island Health, “An electronic chart is an essential part of being able to bring the hospital into the patient's home. All with the goal of improving patient care so that we have seamless communication between clinicians about patients’ statuses and their health schedule”.

She continues, “The nurses use iView in real time in the patient's home, or they'll just sit on a park bench and finish doing their documentation. But they're documenting in real time. And then if the patient needs to come back to the hospital, it's just a seamless transition because everyone can have the same documentation at their fingertips, whether it's the nurses that are on the brick and mortar building wards, or the nurses that are in the Hospital at Home program just driving to see the patients.”

Prioritising the patient

With the groundwork in place, Island Health was able to concentrate on making Hospital at Home the patient-focused program it set out to achieve. By engaging with patients, the team were able to discover the things that really matter to the people they were caring for, such as clear medication records.

As Dr Spina explains, “Through the journey where we've captured the patient experience, we heard loud and clear from them that they wanted something that was more patient friendly. So in collaboration with Oracle Cerner, we actually developed a patient-friendly medication administration record. I understand it's one of the first in Canada to be utilized.”

Some of the key changes involved putting dosage times in clear and obvious places, using larger fonts with simplified naming conventions, and removing codes and admin-related sections that aren’t required by the patients. Crucially, the original information remains on the clinicians’ view, so their ability to perform their roles isn’t affected.

Patient engagement also resulted in examining a virtual call bell for Hospital at Home patients. As Dr Spina explains, “Very similar to if you’re in a hospital, you push a call button, and a nurse will actually come down and see you in your room. If they notify the team that they need assistance, we can get to them in about 25 minutes, all in the spirit of being safe. We’re looking at how to fully implement this in the future”.

Expanding the system

 Island Health has the ambition to roll out this facility to more people within the region, something Dr Spina admits will be difficult in some places, but still achievable. “We do know that healthcare delivery to our rural and remote areas is really important. I don't have all the answers to how we do it right now… but we do have the ability, I believe, to actually deliver healthcare to these areas”.

The organization also anticipates offering Hospital at Home for people in long-term care facilities, so patients don’t have the upheaval of having to visit another healthcare location. As Robyn Candell explains, leaving a space they feel safe “usually sends them spiralling into a worsening situation, because everything's new to them, dementia increases, other problems increase. So if we can bring the hospital into long-term care facilities, we feel like we will have much better outcomes for those patients”.

This has already been seen not just with patients, but with clinicians too. Robyn notes they “enjoy going to see their patients in their own homes, [as] they actually have a better picture of the patients and of what they're trying to prepare them to get back to”. In a survey carried out by Island Health, 86% of patients and 75% of caregivers rated their experience of Hospital at Home as 10 out of 10, with marks in excess of eight receiving scores of 97% and 98% respectively.

Recognition has also come from an expert healthcare body, with the Canadian College of Health Leaders naming Island Health as the recipient of the Excellence in Patient Experience Award for 2022.

With its mix of stakeholder engagement, constant monitoring, innovative technologies, and – most of all – happy patients and multidisciplinary care teams, Island Health’s Hospital at Home could be in line for further recognition as it continues to evolve.