HOSPITAL IN THE HOME (HITH) INFORMATION SHEET

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1 What is HITH? HOSPITAL IN THE HOME (HITH) INFORMATION SHEET In 1994 the Hospital in the Home (HITH) Program was commenced as a pilot. Hospitals were invited to apply to become HITH providers and 43 were selected. 47 services now deliver HITH across Victoria. Hospital in the home is the provision of hospital care in the comfort of the person s own home, or other suitable environment. Patients are regarded as hospital inpatients and remain under the care of their treating doctor in the hospital. Patients receive the same treatment that they would have received had they been in an inpatient hospital bed. Patients may be able to receive all their hospital care in HITH or they may have a stay in hospital then receive HITH in the latter part of their treatment. Participation in HITH is voluntary patients and their carers must agree to have their care provided at home. There are no additional charges to patients for being in HITH. Aims of the service The delivery of acute hospital treatment at home for inpatients who are medically stable enough to be at home and therefore do not require frequent monitoring. Co-ordination of RMH care with GP s and community based services Improved patient satisfaction: Research findings demonstrate that patients have improved outcomes and recovery at home against a range of clinical markers including delirium, confusion and clinical symptoms. (Caplan G. MJA 2006;184(12): ) More efficient utilisation of beds within hospitals Reduction of cost to the hospital; HITH can be provided at a lower cost than inpatient hospital care

2 HITH at RMH HITH is based within the hospital city campus on 7 West and consists of a multidisciplinary team including a Medical Director, Registrar, Clinical Nurse Manager and a team of nurses. The HITH team works closely with the referring parent unit, patient and relevant carers or family members to develop a realistic plan of treatment and care of the patient in their home. The HITH nurses provide acute nursing care in the home, which involves support via a 24 hour on-call service, education and advice for the patient and their carer. Discharge planning is also implemented in consultation with the referring unit, GP and appropriate community based services. How are patients accepted under the HITH program? Patients may be admitted to HITH a few ways, depending on their treatment and condition. Patients may be admitted directly from the Emergency Department and in some cases from their own GP. Other patients may have been treated in hospital for a while, and once their condition has stabilised can then be transferred to HITH for continuation of treatment (for example after surgery or for a further number of weeks worth of IV antibiotic treatment) A referral is received from medical staff and a HITH nurse will visit the patient to assess their suitability based on the criteria outlined over the page. Common misconceptions about HITH: Hospital in the Home: Is not a Community Nursing program. We are an acute medical unit providing care in the private residence setting. Patients remain inpatients for the duration of treatment. Patients are not discharged into HITH, but transferred. Is not an early discharge stream. There are admission criteria which must be met for staff and patient safety, and DoH reporting. Is not the same as the RDNS. We are an inpatient unit of RMH. Is not a substitute or part of Post Acute Care. HITH provide acute medical and nursing treatment. Are not responsible for contracting patients to other HITH services. Is not the referral service for these programs.

3 Patients must meet the following criteria in order to be considered eligible for hospital in the home They require acute in-patient services but are medically stable enough to be treated at home The patient lives within the RMH catchment area (see next page for map, and further on for out-of-catchment guidelines) A good support network (family/carer) is available to the patient Their home is suitable (a routine risk assessment is carried out with all patients) The patient has access to a telephone There is a medical request/approval for transfer The care required is clearly defined including a clear diagnosis and full past medical/surgical history There is a clear end date for the proposed HITH treatment The patient chooses to enter the program voluntarily

4 Royal Melbourne Hospital HITH catchment area The above map should be used as an indicator only. Whilst we do cover most of this geographic area, we also need to balance this with patient acuity and existing workload, and may not always be able to accept patients just because they fall within our catchment. We do cover the furthest outlying areas as they are readily accessible via freeway. At times we may decline patients outside of these major centres as they may not be as readily accessible by major roads. Should we consider a patient to be living in too remote an area despite being in catchment, we still may decline due to patient safety and access to emergency services. HITH will always endeavour to accommodate referrals in most instances, but never at the expense of patient safety.

5 Out of catchment guidelines Hospital in the Home is a medically led acute inpatient substitution unit, with a Medical Director, Registrars and a compliment of nurses. Inpatient substitution entails providing the same level of acute nursing and medical care and supervision as an on campus admission, in the patient s private residence. The significance of being a stand alone medically led unit, as opposed to a nurse led unit where medical supervision is provided by an on campus medical unit, is that the care of HITH patients is directed by the HITH doctors. The HITH doctors do a daily ward round to each patient s home. Hospital in the Home cannot manage patients out of the MH catchment as both our doctors and nurses would not be able to visit due to distance. Patients declined by HITH due to catchment considerations either remain on campus, or are transferred to another appropriate health service. We do not commonly contract out to private nursing services, as our doctors would be unable to visit and direct care. Hospital in the Home cannot arrange for admission into another Hospital s HITH. Hospital in the Home do not contract patients to other HITH units. Should a patient require Hospital in the Home services and reside out of area or in a regional town, the options are: 1. Patient stays in MH catchment area with family or friends for treatment, and will be seen by us. They may also pay for private accommodation for the duration of treatment. 2. Patient is transferred to the nearest centre for management. The receiving hospital makes ongoing management decisions, and decides how they will provide the care, whether that be HITH or on campus. Patients have the right to be cared for at the nearest hospital to where they reside, should that centre be able to provide the service.

6 HOSPITAL IN THE HOME (HITH) REFERRAL CHECKLIST Please see over page for a list of home based treatment HITH undertakes (not exclusive) 1. DISCUSS PROPOSED HITH TREATMENT WITH PATIENT HITH is a voluntary service and some patients may not wish to receive home visits. Therefore it is important that the HITH referral is discussed with the patient before a HITH nurse arrives to assess that patient. 2. CONTACT HITH REGISTRAR Via RMH switch and give a full medical handover of the patient. Unsuitable patients will be declined. Our Registrar will then contact the HITH Triage Nurse. 3. COMPLETE A HITH REFERRAL FORM This form must be completed by referring medical staff and signed before a HITH nurse will attend the ward to assess the patient. Forms can be found on all wards and has a green border. (See rear of folder) A nursing handover will be taken at this time. 4. WRITE UP A HITH DRUG CHART This should include the medication HITH is required to administer plus the patient s regular medications and weight of patient should they require anticoagulation therapy. Please also order required HITH medication with ward pharmacy prior to patient transfer and send to 7 west. For post-op patients on Warfarin please write up 3 days worth of doses. 5. PROVIDE 3 DAYS WOUND DRESSINGS Please supply should the patient require wound dressing, plus a completed wound chart. 6. TRANSFER PATIENT TO HIH ON ipm AND SEND COMPLETED MEDICAL HISTORY TO 7 WEST Patients should not be discharged, but transferred, as the patient remains an inpatient. Competed medical histories should not be sent to HIS, but to 7 West as the care episode is not over. All of these steps must be completed prior to HITH accepting a patient, to avoid delays.

7 HOSPITAL IN THE HOME COMMON HITH HOME BASED TREATMENT FOR THE FOLLOWING CONDITIONS ANTICOAGULATION PE, DVT, AF, Pre & Post Op SHORT TERM IV ANTIBIOTICS (Via cannula) Cellulitis, Wound Infections, Pneumonia, Pyelonephritis LONG TERM/TDS QID IV ANTIBIOTICS (Via PICC or HICKMANS) Sepsis, Endocarditis, Osteomyelitis, Chronic wound infections, CMV reactivation. COMPLICATED WOUND CARE Wound breakdown, VAC s DIABETES MANAGEMENT Insulin education for patient s new users or re-education for unstable diabetes including technique supervision, and BSL monitoring. POST OPERATIVE CARE Drain tube management including: Recording output and removal where specified. OTHER Above are our most common conditions and treatments. We occasionally provide alternative treatments for conditions not listed above which would need to be agreed with our HITH Reg, contactable Via switch. For more information on HITH please see website:

8 INSTRUCTIONS FOR TRANSFERRING PATIENTS TO HITH FROM: EMERGENCY DEPARTMENT Select 'ward view' Locate patient Right click and select 'transfer/leave' option Click on 'transfer now' or manually enter the date and time of transfer. Select ward 'C Hospital in the Home' Select an available bed Select transfer reason as 'change of ward' Select 'clinician tab' Type 'monm' in new clinician field Select 'hospital in the home' in specialty field Transfer reason is 'referral to other clinician' Enter relevant date Select 'OK' Select 'yes' Then if applicable, track the medical history to hospital in the home. INSTRUCTIONS FOR TRANSFERRING PATIENTS TO HITH FROM: WARD Select 'ward view' Locate patient Right click and select 'transfer/leave' option Click on 'transfer now' or manually enter the date and time of transfer. Select ward 'C Hospital in the Home' Select an available bed Select an available bed Select transfer reason as 'change of ward' Select 'OK' Select 'yes' Then if applicable, track the medical history to hospital in the home.