Hospital at Home (H@H)

The first of its kind in the province, our H@H program was developed to create capacity and maintain access to specialized care during a significant increase in the number of COVID hospitalizations during the pandemic. Patients received hospital-level care in the comfort of their home, with 24/7 remote monitoring supported by an interdisciplinary team. The program was launched in 72 hours, thanks to coordinated cross sector collaboration and integration of staff with medical restrictions preventing in-person hospital presence, to care for patients during COVID. The success of the H@H program has prompted the Ministry of Health to launch a province-wide initiative for the implementation of H@H in select hospitals across Quebec.
Patients, particularly the elderly, become deconditioned when hospitalized, confined to their beds or a small hospital room. At home, this deterioration is mitigated by being in a familiar setting, surrounded by a knowing care network. Our program aims to provide value-based care, supported by data and digital transformation, with the goal of improving patient outcomes while operating in a model that is sustainable for the healthcare system. The H@H program now spans multiple medical and surgical trajectories allowing patients to continue their “hospitalization” in their home environment, while being cared for by a multidisciplinary virtual team with 24/7 remote monitoring of vital signs through use of Internet of Things (IOT) technologies. The program admits patients with a variety of diagnoses from over 30 established trajectories. Patient partners are engaged routinely in evaluating and actioning quality improvement plans, as well as in assessing comfort and usability of wearable devices. Our services are integrated across typical care silos, crossing multiple disciplines, including primary, specialized, acute, and home care. The unit boasts a 25-patient capacity, with 900 patient admissions since its launch, representing 4000 bed–days. The program is part of the CIUSSS’s internal structure, under the Directorate of Quality Transformation, Evaluation, Value, Clinical & Organizational Ethics, and Virtual Care. The clinical team comprises about 20 FTE, including 1 head nurse, 2 assistance head nurses, 1 nurse educator, 2 administrative support staff, and a team of nurse clinicians caring for patients 24/7. It operates with a hybrid medical model; closed unit for Medicine and an open unit structure for other specialists (such as Surgery and Family Medicine). In-person care is provided by the community nursing team, with whom the H@H team has a close and collaborative relationship. Care is coordinated through the organization’s Command Centre, the digital central nervous system of our healthcare network, wherein real-time data is monitored and used to guide decision-making and identify organizational and operational best practices, to further integrate care teams across the continuum.
The H@H program generates value through creation of access, efficiency in use of human resources (3137.5 hours of salary insurance saved in the first year), financial gains (projected savings of 1.7M in recurrent operational costs/year), and patient experience (93% preferred this model). More importantly, patient reported outcomes are rated higher in every measured domain, compared to hospital ratings. The program boasts low morbidity and mortality rates, meeting comparable standards to in hospital care.