Will hospital-at-home system be better for Irish patients?

Minister for Health Stephen Donnelly has announced the rollout of a hospital-at-home programme for patients of two public hospitals next year.

Any broadening of service delivery in our beleaguered public health system is welcome. But a key question for patients is: will the provision of virtual wards using a hospital-at-home concept provide better care for recipients?

Hospital at home/virtual wards is not a new concept. It has been available in the United Kingdom and the United States for some time, and it is already available to some private patients in Ireland.

For example, VHI Healthcare members along the east coast and in the Galway area can be referred by their hospital consultant or GP for specialist team care in their homes.

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The main driver of virtual care at home is to avoid hospital admission or to enable an earlier discharge from hospital.

Virtual care works for a number of defined medical conditions: for example when someone needs intravenous antibiotics for severe infections such as pneumonia, urinary tract infection, cellulitis (a severe inflammation and infection of the skin) and postoperative infection. It may also facilitate treatment with injectable anti-coagulation, intravenous hydration and total parenteral nutrition.

When run and resourced properly, hospital at home provides the equivalent of hospital level care. It is heavily technology dependent and may include a suitably enabled tablet for video visits with a virtual care team; a phone that connects to that team; a wearable device that continually tracks the patient’s vital signs; a blood pressure cuff; and a pulse oximeter.

[ Patients to be treated at home under new ‘virtual ward’ programme ]

Contact is made with the patient by a professional team member at least once a day. The assessment may be in person or more commonly it will be carried out virtually by video consultation. Each team is led by a clinical nurse manager and includes doctors, therapists and other health professionals.

Why would someone with an appropriate medical condition opt for virtual care at home rather than hospital admission?

There are definite advantages for older patients. Being in hospital carries its own risks. Falls happen more often in unfamiliar surroundings. Superbug infections break out. Sleep suffers from constant interruptions and alarms. And moving from home to hospital can precipitate cognitive issues, leaving older adults unable to function when they return home.

So from a holistic perspective offering hospital at home to select patients may offer better care. But two important caveats must accompany the Minister for Health’s announcement.

Virtual care can only function as an opt-in decision made by the patient. Participation must be voluntary and never coercive.

Tempting as it may be for politicians and health service administrators to portray virtual care as an alternative to additional hospital beds, this will not wash. As this newspaper’s health editor reports, despite the addition of more than 1,000 hospital beds in the State since 2018, Ireland still has one of the lowest number of beds in Europe relative to population.

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