BC invests $42 million in hospital-at-home

VICTORIA, BC – British Columbia is piloting a “hospital-at-home” project at the Victoria General Hospital, which is designed to treat some patients in their homes instead of in hospital beds. With funding of $42 million, the plan is to fine-tune the project in Victoria and Prince George, and to roll-out the solution to hospitals across the province this winter.

The goal is to relieve pressure on bricks-and-mortar facilities as the COVID-19 pandemic continues. As well, it’s believed that many patients will have better outcomes in their homes rather than in hospitals, especially when it comes to rates of infection and delirium.

The program is expected to treat mainly elderly patients with chronic heart failure, lung disease or pneumonia, or illnesses that require short-term medical intervention, such as intravenous antibiotics or oxygen, according to information provided by the provincial Ministry of Health.

The patients will be admitted to hospital, but will remain at home, where they will receive daily in-person care from a team led by a doctor or nurse practitioner with admitting privileges, supplemented with virtual care.

The project is being led by Victoria hospitalists Dr. Elisabeth Crisci (pictured on left) and Dr. Shauna Tierney (pictured on right). Dr. Crisci first saw the hospital-at-home (HaH) concept in action a few years ago while doing fellowship training in Australia, the Doctors of BC website reported. “This was not home and community care. It was acute, hospital-level care: IV medications, blood transfusions, oxygen. ”

“A hospital is an unsettling environment, especially for frail and elderly patients,” she said. “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 HaH and in 2019, an opportunity came up to take action. Her 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”.”

HaH could also help to ease some capacity pressures in hospitals, with 5 to 10 percent of admitted patients able to meet the clinical criteria for management in their homes.

Dr. Tierney and Dr. Crisci gained support of Island Health, South Island Hospitalists and the Divisions of Family Practice, and eventually, the Ministry of Health. Funding from Health System Redesign and Facility Engagement made it all possible.

As agents of change, they had to challenge some old-standing beliefs. “We argue that what should define hospital-level or acute-care is the type of patient and the type of clinical interventions required, rather than 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 from the BC Ministry of Health to ensure alignment with the BC Hospital Act. “Even at home, these patients are admitted and under the responsibility of the hospital.”

To their delight, the Ministry was interested in doing much more, and in September 2020, announced that HaH would be introduced to BC. While there are details to iron out to pilot HaH at Victoria General Hospital and eventually scale it to other hospitals, a full-time project team is on board to take it over the finish line. The doctors are continuing as medical leads.

“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 healthcare system,” said Dr. Tierney.