The Efficacy of Telemedicine-Supported Discharge Within an In Home Model of Care.

OBJECTIVE: To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes. METHODS: A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method. RESULTS: Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained. CONCLUSION: The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.

Patient and multidisciplinary health professional perceptions of an Australian geriatric evaluation and management and rehabilitation hospital in the home service.

OBJECTIVES: Hospital in the Home models are rapidly expanding in response to increasing bed pressures. This study examined patient and multidisciplinary health professional perceptions of a new geriatric evaluation and management and rehabilitation hospital in the home service in Australia. The service was unique, as adults of all ages with a variety of rehabilitation or geriatric evaluation and management needs were within scope. METHODS: A qualitative descriptive approach was used with a consumer co-researcher and a consumer advisor being integral to decision-making. Patient feedback was collected via a paper-based patient satisfaction survey between August 2020 and February 2022. Additionally, interviews with current and past staff were conducted from July to November 2021. Reflexive thematic analysis was conducted for qualitative data and descriptive statistics used for quantitative data. RESULTS: Patient surveys were analysed (n = 199, 42.2% response rate) with 60.8% of participants aged 75 years or over and 26.6% speaking a language other than English. High satisfaction was expressed. Feelings of comfort, familiarity, convenience, and reassurance were voiced. A person-centred approach enhanced involvement in care. Challenges included carer burden and clear communication. Sixteen staff (33% response rate) were interviewed. In general, staff said the service was inclusive and responsive, and the home environment beneficial, particularly for patients from culturally diverse backgrounds. A strong hospital partnership and comprehensive multidisciplinary approach were vital. Challenges included fragmentation due to part-time roles and combining with a pre-existing acute hospital in the home service. CONCLUSIONS: This qualitative exploration of staff and patients' perceptions of a geriatrician-led, multidisciplinary geriatric evaluation and management and rehabilitation hospital in the home service demonstrated that it was person-centred and optimised patients' control and ownership of care. The inclusive service parameters ensured responsiveness to diverse needs whilst allowing earlier return home from hospital, both of which are vital for quality patient care.

Evaluation of a novel sub-acute Hospital in the Home model for providing inpatient geriatric and rehabilitation services.

ObjectiveTo report on the development and implementation of a multidisciplinary, sub-acute Geriatric Evaluation and Management Rehabilitation Hospital in the Home (GEMRHITH) model of care with the initial 2years' service outcome data (October 2019 - September 2021).MethodsA retrospective analysis was conducted using hospital centralised data, and the GEMRHITH internal service database. Descriptive statistics were used to describe the patient population. Student's t-test was used for comparative data.ResultsOver 2years, GEMRHITH admitted 617 patients (13%, n=82 directly from the emergency department). Median age was 82years (range, 32-102 years), with 60.5% (n=373) being female and 39.5% (n=244) presenting with moderate frailty. Most patients (79.6%, n=491) entered from a medical speciality (28.5%, n=178 from neurology). Average GEMRHITH stay was 6days (range, 1-33 days). Average bed occupancy was 5.3 virtual beds. There was an average of 26 discharges per month with 97% of patients (n=598) discharged to their own home. Transfers back to the emergency department with the same diagnosis-related group were low (3.6%). The 7-28day re-admission rate was 2.3%. Service safety was high, with only eight hospital-acquired complications reported in seven patients. Significant improvements were noted for total and sub-scale Functional Independence Measure scores (P<0.001).ConclusionsThe addition of rehabilitation and geriatric care to traditional HITH services provides opportunities for multidisciplinary teams to support a larger cohort of patients with various medical and surgical conditions and functional abilities, to efficiently transition home from hospital settings. There were minimal complications and occupied bed stays were saved within a hospital.