Having an official online community is also another step towards becoming a single-entry point and reliable source in the World Hospital at Home field.
Thank you for this great initiative!
Sharing experiences and opinions with colleagues around the world, would be an excelent way to learn and improve our practices.
Best wishes for everyone
If I can suggest we could introduce ourselves so we would know where each one is and what they do.
I am Marcos Domingues, CEO of Qualivida Out of Hospital Health Care Platform, we do most of hospital procedures at home, from single professional visits to full 24h monitoring of an Intensive Care room at home including Infusion treatments. Our head officce is in Salvador, Bahia, Brazil and we have operations in most of the Northast Coast states.
Hope to share our experience and learn from each one of you too.
In Israel, the Ministry of Health had just issued the draft of the HaH regulations. I will get it translated (I do not rely on your Hebrew....) and will share it soon.
I believe it will be great to share here the different regulation documents from the different countries.
Notice: In "regulation" I mean the general HaH document (where it exists) and not specific regulations for specific procedures/treatments.
thanks for sharing that news, Itamar. in the US, we recently formed a HaH User Group of active programs. The User Group has established 3 working groups: 1) HaH Program Standards, 2) HaH Quality Measures, 3) Policy and Regulatory issues. we will be very interested to see the regulations from Israel.
However, a very practical way to improve our HAH is by offering a summary of the consensus created in Madrid at the WHAHC, as a publication that could already subsidize decision makers in each country.
And respondind Dr Itamar Offer, the main message from the 1st WHAHC was that" we are a tribe"- as said by Dr Leef, we are not alone, and we have some challenges in common :
• Creation of the culture of AD, especially in professionals - of care for the patient and his surroundings;
• Define exactly the profile of the patient to be admitted (correct eligibility);
• evaluate Transport time x care time;
• Technology incorporation (the right technology for the right person);
• Create evidence of good quality;
• Be intensive, complex and transient point of care;
• Have a model based on the patient / population NEEDS;
•We have to matrix primary care, especially in remote areas (including telemonitoring);
• Shape staff and compensation to the prevalent care profile: acute / chronic / palliative care / others.
Thanks a lot for very important comments, mainly regarding our common role in building consensus around specific professional challenges within the HaH service.
We will bring up some of the topics you have shared as Topics for discussion in an attempt to start building consensus drafts while enjoying the wisdom of the whole WHAHC community. Some of those may become a basis for mutual research ("multi-center") in order to establish them as standards of care. Looking forward. Itamar
In Israel, we have decided that since we are entering the patients' homes, for an average of 3-5 days (ALOS), and since those same patients and their caregivers were responsible for managing their own oral chronic medications before we came, and will be the day after we leave, that they continue to be responsible for managing them during the period they are hospitalized in our HaH service.
The physician is changing the medications regime if required due to the acute disease or the IV intervention (not common), but in large, they just continue with their daily routine.
In terms of patient safety, we believe that any other option that includes changing the patients' routine is compromising the safety of the patient. Good luck.
Thank you, Itamar, for your response. While I would love to attend the conference in Spain, I'm planning on attending the conference in Chicago. I'm not sure if you are on Facebook at all, but I've created a group for Hospital at Home that's for everyone to network and ask questions. It's simply called Hospital at Home and is currently the only one that is public. Please, join us and invite others. Thank you so much!
Hi Amanda, congratulations on the new program!
Typically in Australian HITH services, the patients/carer/nursing home staff will administer all oral medications - as Itomar indicates, it is typically considered safer than changing to HITH managed administration, and then back again, plus many oral medications are 2,3,4 times per day which is beyond our typical visit capacity (certainly 3 or 4 in most cases). Time is spent prior to transfer and again in the home with the (oral) medication list the physical medications themselves and running through how the patient/carer will manage them. "Webster packs" or similar oral medication assistance "devices" can often be instituted at this stage if there is concern abut missed doses etc.
Cabrini Health, Melbourne, Australia.
Many Australian hospitals already have processes to support medicine self-management for selected patients when they are admitted into the physical hospital and often the same processes are used for patients receiving care in the home. Many borrow from the approach used in residential care, focus on self-administration of usual medicines, patient-controlled analgesia or symptom control and more recently moving to self-administration of selected medicines like insulin. Having some guidelines about patient and medicine selection helps, of course it's better if you have clinical pharmacy as part of the HITH team! A few links that may help