- Physicians Lead the Way to Hospital at Home
Victoria Hospitalists Dr. Elisabeth Crisci and Dr. Shauna Tierney have been unwavering in their pursuit of a new kind of care for patients. Now, their passion project is about to become a reality with the BC Government’s launch of Hospital at Home across the province.
With Hospital at Home (HaH), acutely ill adult patients who are at lower risk and have a predictable clinical path can get hospital-level care from a team of professionals at home, safely and effectively. The model has been used for years in countries like Australia and the UK.
Extensive studies, including three Cochrane reviews (Ref 1), show that HaH provides equivalent or better clinical outcomes than standard hospitalization. Length of stay tends to be shorter and there is a higher level of satisfaction amongst patients, their caregivers and healthcare workers. It also shields patients from some of the complications associated with a brick and mortar hospital stay.
Dr. Crisci first saw HaH in action several years ago while doing fellowship training in Australia. “This was not home and community care. It was acute, hospital-level care: IV medications, blood transfusions, oxygen. There is no doubt in my mind that those patients, if they were back in Canada, would need to be on a hospital ward.”
“A hospital is an unsettling environment, especially for frail and elderly patients,” she says. “I thought, ‘why can’t we do the same in Canada?’ The expertise and therapies that we associate with hospital care are all portable, and so is the hospital staff.”
“It is an opportunity to offer safer, more patient-centered care for our patients and for less cost. It is the right thing to do.”
Back in Canada, she often thought about the HaH model. Then, in 2019, an opportunity came up to take action. Her Hospitalist colleague, Dr. Shauna Tierney, was reading about a HaH program for COPD and was inspired.
“I saw that we could do better for our patients’ dignity and comfort, and thought, “we have a moral imperative to do this." - Dr. Shauna Tierney
Dr. Tierney reached out to Island Health and her Hospitalist colleagues to see what could be done. Dr. Crisci was ready. “We knew that we needed to join forces to make this happen.”
Left: Dr Elisabeth Crisci. Right: Dr Shauna Tierney
Collaboration moves the vision forward
The two physicians would need help to develop a HaH program for BC– including the buy-in and support of the Island Health, South Island Hospitalists, the Divisions of Family Practice, and eventually, the Ministry of Health. Funding from Health System Redesign and Facility Engagement made that possible.
“Over the past year we worked relentlessly to get the level of engagement this project requires, while developing our own HaH program for B.C.” says Dr. Tierney. It meant that they had to become agents of change, inspire others to think outside of the box, and challenge some old-standing beliefs about how hospital-care can be delivered.
“The same old thinking will always give you the same old results,” says Dr. Crisci. “We argue that what should define hospital-level or acute-care is the type of patient and the type of clinical interventions required, rather that adhering to a definition based on the physical location of the patient.”
Taking the hospital team and interventions to the patient's home would require further support, which they sought from the BC Ministry of Health. “We don’t want this to be just another community-based service,” says Dr. Crisci.
“We want a true substitute to a standard hospital admission. For this to be possible, we have to ensure that these patients fall under the governance of the provincial Hospital Act. This means that even if at home, these patients are admitted and under the responsibility of the hospital.”
To their delight, the Ministry was interested in doing much more with HaH, and in September 2020, announced that BC would introduce the model to Victoria, and then spread it across the province. In part, HaH can help with the government’s COVID-19 planning by freeing up some acute care capacity.
While there are details to iron out to pilot HaH at Victoria General Hospital and eventually scale to other hospitals, a full-time project team is in place to take the work over the finish line. The doctors are continuing as medical leads.
They note that experienced physicians on the ground are uniquely positioned to bring innovative ideas such as this to the fore. But they could not have done it alone. It took everyone’s help to make their vision a reality.
“It has been quite an adventure. It started with two physicians with an idea, and now HaH is one of the priorities for BC’s health care system,” says Dr. Tierney.
“The collaborative effort between the Ministry, Island Health and the front-line physicians has been incredible; something I never thought I’d ever witness in my career,” agrees Dr. Crisci. “Here we are, side-by-side, to not only improve the care of patients but also working to make our system a bit more sustainable.”
"I can’t wait to see that first patient’s face when I can say, “you get to go home, and I will come to see you at home.” - Dr. Elisabeth Crisci
Funding for physician engagement in the HaH project was provided by Health System Redesign (HSR), an initiative of the Joint Collaborative Committees (JCCs) – a partnership of Doctors of BC and the Government of BC – and the South Island Medical Staff Association, funded through the South Island Facility Engagement Society and Specialist Services Committee (one of the four JCCs).
Ref 1: Cochrane Reviews
"Facility Engagement in Action" highlights a few examples of the hundreds of successful activities across BC that are making a difference. Read it here >