A program to deliver acute care to patients who can safely recover in their homes rather than hospital has expanded to Cowichan District Hospital.
The province launched the Hospital at Home program at the hospital in April, providing $3.8 million in funding over four years to accommodate patients who want to recover at home — freeing up beds for those patients who must be admitted and remain in hospital.
Twenty-six patients have already taken part, said Emma James, Island Health executive director of clinical service delivery for the Cowichan Valley.
The program was piloted at Victoria General Hospital in 2020 and expanded to Royal Jubilee Hospital the next year, and has served more than 2,000 patients, according to Island Health. It’s also available at four hospitals in the Vancouver area.
Patients receive an in-person, phone or virtual visit from a doctor, a daily in-person visit from a nurse, and around-the-clock phone access to a nurse.
The larger team includes nursing unit assistants, allied health care workers, and pharmacists and can include physiotherapists, speech-language pathologists and dietitians.
Island Health said therapies and tests, such as vital signs monitoring, supplemental oxygen, IV therapy medications and blood work, can all be done in the patient’s home.
Dr. Maki Ikemura, executive medical director for Cowichan District Hospital and an in-patient physician for the Hospital at Home program, says whereas some programs might have an exclusive team, the Cowichan model works differently.
“There are physician shortages everywhere, we would not have been able to stand up a completely new team of physicians,” Ikemura said.
While individual physicians have individual approaches, the program’s physicians typically connect with their Hospital at Home patients online or by phone as part of their in-person patient rounds in hospital.
The doctors have access to the results of the patient’s monitoring machines and lab work. A nurse, meanwhile, would follow up in person in the patient’s home.
In addition, community physicians have stepped forward to join the program, and “that’s been really helpful for us,” Ikemura said.
Ikemura said “overwhelmingly” the patients she’s seen report feeling more secure at home in a familiar environment with loved ones, with support from nurses and daily check-ins with a physician.
Hospital at Home patients remain registered as “admitted,” which gives them the security “that if something were to get worse, then they can come back into the hospital directly,” rather than having to go through the emergency department, Ikemura said.
As a physician, she feels confident “they’re going to get better faster, because they’re home.”
Claire Killick, a former patient of the program at Cowichan District Hospital, said the in-person and virtual visits from nursing staff “gave me the confidence to know that I could safely complete my recovery from the comfort of my own home.”
Participants must have a caregiver and be at least 19 years old, be referred to the program, and live within the hospital’s catchment area or no more than a 30-minute drive away.
Eligible patients must have a known diagnosis from which they can safely recover from at home in about two weeks. They cannot be in a pain crisis, have an unstable psychiatric disorder, or have had an acute stroke, and they must abstain from substance abuse.
The program recently broadened its eligibility criteria to include palliative care, nephrology, infectious disease, gastroenterology, respirology, internal medicine, cardiology, cardiac surgery, general surgery, urology, geriatrics, according to Island Health.
The program is not designed for patients who require multiple diagnostics and procedures that can’t be completed at home, such as CT scans, X-rays, electrocardiograms, or transfusions but they can be arranged if required.
Health Minister Adrian Dix said in a statement that after the successful pilot in Victoria, people in Duncan and surrounding areas now have expanded access to hospital-level team-based health care at home.
“We’re committed to growing and strengthening people’s access to high-quality health services and this is just one way that we are doing so,” he said.
