Victoria HaH program team members (left to right): Sean Spina, Regional Clinical Pharmacy Manager, Island Health and Evaluation Lead; Dr Shauna Tierney, Medical Lead; Melanie Cyr, Tertiary Director of Operations, Emergency and Medicine, Royal Jubilee Hospital (photo submitted)
A collaborative initiative to ease pressure on hospital bed capacity and improve patient experiences is reducing hospital stays while maintaining or even improving outcomes.
In 2019, Drs Shauna Tierney and Elizabeth Crisci set out to introduce Hospital at Home (HaH) to British Columbia, aiming to provide safe, effective, hospital-level care to lower-risk adult patients in their own homes.
The Victoria-based hospitalists engaged extensively with health care providers, Island Health, and the Ministry of Health to gain support for piloting HaH in BC. Its success has resulted in the creation of 24 new HaH bed spaces in Victoria, providing 17,500 days of hospital treatment to patients by 2024.
“In Victoria, we're basically running a 24-bed unit without having to build an actual physical ward, says Dr. Tierney. "We're borrowing it from the patient.”
HaH has since expanded to Duncan, four Vancouver hospitals, and Prince George, and was recently honoured at the 2024 Premier’s Awards as a finalist in the category of Innovation.
Collaborating for transformation
Dr Teirney is the current medical lead for HaH in Victoria. She highlights that Covid-19, virtual care technology, and mounting pressures on hospital bed capacity helped fuel its rapid growth.
Collaboration has also been a key success factor. A partnership with Island Health – including Executive Sponsor Marko Peljhan – brought together multidisciplinary teams and essential hospital services to develop an operational model.
Physician engagement was supported by South Island Medical Staff Association Facility Engagement funding and Health System Redesign, joint initiatives of Doctors of BC and the Government of BC.
Improving patient experiences
An internationally recognized model of care, HaH is designed for patients with predictable clinical conditions. Dr. Tierney estimates that about 75 per cent of eligible patients choose HaH when offered.
At home, patients get daily wraparound care with virtual or in-home visits from a physician, in-person visits from an acute care nurse and other multidisciplinary providers, and around-the-clock access to the team.
They may receive services such as supplemental oxygen, IV therapy, and blood work. Technically inpatients, they can access the onsite services of the hospital as well.
How patients are responding
After its first year, 99 per cent of patients who received HaH in Island Health said they would recommend it, 98 per cent of caregivers felt confident in their roles, and all staff expressed full support for HaH. A cohort control study, soon to be released, showed equal or better clinical outcomes compared to traditional care in the hospital.
Dr Tierney continues to receive positive feedback from patients, with some reflected in a 2022 national Excellence in Patient Experience Award for HaH’s patient-centered approach to care.
“With bricks and mortar, it's about what's convenient for practitioners,” she says. “With Hospital at Home, it is about what’s convenient for the patient, the one who is actually suffering.”
Delivering meaningful patient-centered care
In Victoria, about 12 hospitalists staff the HaH service for a week every one to two months. Dr Tierney says a higher level of clinical experience and risk tolerance helps when providing at-home acute care, away from the resource-dense, supportive environment of a hospital.
She notes there are both challenges and rewards for physicians and care teams in shifting to a form of medicine that is truly patient-centric.
“Despite the added uncertainty and inconvenience of providing medical care this way, it’s worth it,” she says. “There’s a deep sense of providing good care. Patients are happier, they tend to get better faster, and they are less likely to need to be re-admitted to hospital after discharge.”
Creating value and savings for the health care system
While more human-resource intensive than centralized inpatient care, Dr Tierney believes the benefits of HaH outweigh the added resource needs when balanced with bricks-and-mortar savings, shorter hospital stays, and improved patient outcomes1 – along with better patient and caregiver experiences.
The Ministry of Health is conducting a financial analysis of HaH that is ongoing.
Moving forward, Dr Tierney envisions HaH becoming a standard part of acute care across the province, with the potential for every hospital to have a dedicated HaH unit. She emphasizes that continued collaboration, learning, innovation, and system support, will help the program to evolve and succeed. See here for the full SSC story...
“We’re currently stretching and dreaming and innovating and supporting each other to optimize the benefit of this way of providing acute care outside the hospital walls,” says Dr. Tierney. “It is a fascinating project and when I get discouraged, I just remember my patients who have told me not to stop; just keep going.”
- Hospital at home: emergence of a high-value model of care delivery
- Hospital at home Expansion with Island Health evaluation highlights
- 2024 Premier’s Awards finalist video
- Island Health: How HaH works
- Vancouver Coastal Health: HaH in action (with video)
- Northern Health HaH program
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