Organization of patient transfer from conventional hospital to hospitalization at home / Organisation du transfert des patients de l'hospitalisation conventionnelle vers l'hospitalisation à domicile

INTRODUCTION: The organization of patient transfer from conventional hospital to hospitalization at home (HAH) is not well known. PURPOSE OF RESEARCH: Our study aims to describe this organization by identifying the key professionals of the pathways and the incentives and obstacles to the continuity of care. RESULTS: Patient transfer from conventional hospital to HAH is a period of strong tension between all health care professionals and the organization of discharge is not sufficiently anticipated by hospital prescribers. The description of the patient clinical state is not always shared between the conventional hospital and the HAH professionals mainly when they do not work together. An HAH physician can be of support. Finally, the HAH nurse has a main role at the interface of the hospital department, the patient, and the home care professionals with an important activity of coordination of interventions. CONCLUSIONS: Patient transfer from conventional hospital to HAH should be anticipated by hospital professionals upon entrance and common needs assessment tools would allow a better security of the pathways.

Introduction: L'organisation du transfert des patients de l'hospitalisation conventionnelle vers l'hospitalisation à domicile (HAD) est peu connue. But de l'étude: Notre étude a eu pour objectif de décrire cette organisation en identifiant les acteurs clés de ce parcours avec les incitatifs et les obstacles à la continuité des soins. Résultats: Le transfert des patients de l'hospitalisation conventionnelle vers l'HAD est une période de forte tension entre tous les professionnels de santé et l'organisation de la sortie est peu anticipée par les prescripteurs hospitaliers. La description de l'état clinique du patient n'est pas toujours partagée entre les médecins hospitaliers et les infirmières de l'HAD, surtout lorsqu'ils n'ont pas l'habitude de travailler ensemble. Le médecin coordonnateur de l'HAD contribue dans ce contexte à construire une vision commune. Enfin, l'infirmière de l'HAD joue un rôle central, à l'interface entre le service hospitalier, le patient et les professionnels du domicile, avec une forte activité de coordination des interventions. Conclusion: Le transfert des patients de l'hôpital conventionnel vers l'HAD devrait être anticipé par les professionnels hospitaliers dès l'entrée en hospitalisation et l'utilisation d'outils communs d'évaluation des besoins permettrait une meilleure sécurisation des parcours.

COVID-19 outbreak: An experience to reappraise the role of hospital at home in the anti-cancer drug injection.

BACKGROUND: The COVID-19 outbreak has posed considerable challenges to the health care system worldwide, especially for cancer treatment. We described the activity and the care organisation of the Hospitalisation At Home (HAH) structure during the pandemic for treating patients with anti-cancer injections. METHODS: We report the established organisation, the eligibility criteria, the patient characteristics, the treatment schemes and the stakeholders' role during two 5-week periods in 2020, before and during the French population's lockdown. RESULTS: The increase of activity during the lockdown (+32% of treated patients, +156% of new patients and +28% of delivered preparations) concerned solid tumour, mainly breast cancer, even if haematological malignancies remained the most frequent. Thirty different drugs were delivered, including three new drugs administered in HAH versus 19 during the routine period (p < 0.01). For those clinical departments accustomed to using HAH, the usual organisation was kept, but with adjustments. Five clinical departments increased the number of patients treated at home and widened the panel of drugs prescribed. Three oncology departments and one radiotherapy department for the first time solicited HAH for anti-cancer injections, mainly for immunotherapy. We adjusted the HAH organisation with additional human resources and allowed to prescribe drugs with an infusion time of <30 min only for the new prescribers. CONCLUSION: HAH allowed for the continuation of anti-cancer injections without postponement during the pandemic, and for a decrease in unnecessary patient travel to hospital with its concomitant COVID-19 transmission risk. Often left out of guidelines, the place of HAH in treating cancer patients should be reappraised, even more so during a pandemic.

Matrix therapy is a cost-effective solution to reduce amputation risk and improve quality of life: pilot and case studies.

INTRODUCTION: Chronic, non-healing ulcers remain one of the most challenging clinical situations for health care practitioners. Often, conventional treatments fail and lead to amputation, further decreasing the patient's quality of life and resulting in enormous medical expenditures for healthcare systems. Here we evaluated the use of and cost-effectiveness of the RGTA (ReGeneraTing Agents) medical device CACIPLIQ20 (OTR4120) for chronic lower-extremity ulcers in patients with Leriche and Fontaine Stage IV peripheral arterial disease who were not eligible for revascularization. METHODS: This uncontrolled pilot study included 14 chronic lower extremity ulcers in 12 patients in one hospital. The pilot study included 12 patients with TcPO2 < 20 mm Hg and ABPI < 0.5 who had either a minimum of one chronic lower extremity ulcer or a chronic ulcer related to amputation. OTR4120 was applied twice a week or until complete healing, for up to 12 weeks. Ulcer surface area reduction (%)after 2, 4, 8 and 12 weeks, appearance after 4 weeks, and healing after 12 weeks were measured and recorded. RESULTS: A 35% reduction in ulcer size was achieved after 4 weeks. 7 (50%) out of 14 ulcers completely healed within 1 to 3 months of treatment. DISCUSSION: OTR4120 is an effective therapeutic option for patients with chronic lower extremity ulcers, can provide major improvement of quality of life and has the added benefit of being a significant cost-effective solution for healthcare systems.