Victoria Hospitalists Dr Elisabeth Crisci and Dr Shauna Tierney have been unwavering in their pursuit of a new kind of care for patients. Now, their passion project is about to become a reality with the BC Government’s launch of Hospital at Home across the province.
With Hospital at Home (HaH), acutely ill adult patients who are at lower risk and have a predictable clinical path can get hospital-level care from a team of professionals at home, safely and effectively. It has been used for years in Australia and the UK. Compared with standard hospitalization, HaH can provide equivalent or better clinical outcomes, shorter length of stay, and higher satisfaction amongst patients, their caregivers and healthcare workers.1
Dr Crisci first saw HaH in action a few years ago while doing fellowship training in Australia. “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 says. “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 per cent of admitted patients able to meet the clinical criteria for management in their homes.
Dr Tierney and Dr Crisci quickly joined forces to develop a HaH program for BC. They would need help, and worked relentlessly to gain the buy-in and 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. Dr Crisci also benefitted from her enrollment in the UBC Sauder Leadership Program offered by the Specialist Services and Shared Care Committees.
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 health care system,” says Dr Tierney.
“The collaborative effort between the Ministry, Island Health and the front-line physicians has been incredible; something I never thought I’d ever witness in my career,” says Dr Crisci. “Here we are, side-by-side, to not only improve the care of patients but also working to make our system a bit more sustainable.”
“I can’t wait to see that first patient’s face when I can say, ‘you get to go home, and I will come to see you at home.’
Funding for physician engagement in the HaH project was provided by Health System Redesign (HSR), an initiative of the Joint Collaborative Committees (JCCs) – a partnership of Doctors of BC and the Government of BC – and the South Island Medical Staff Association, funded through the South Island Facility Engagement Society and Specialist Services Committee (one of the four JCCs).