“Refoundation” of the health system | Home hospitalization soon?

(Quebec) Will being hospitalized at home soon be possible? The Jewish General Hospital (JGH) in Montreal is rolling out a pilot project to help patients make a full recovery in the comfort of their own homes. A solution recommended by the Federation of Medical Specialists of Quebec (FMSQ) and attractive in the eyes of Christian Dubé.

Fanny Levesque
The Press

The Jewish General Hospital of the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal is betting on caring for a very specific category of patients at home. “We have to rethink the way we administer care,” says the CIUSSS’s assistant director of quality, innovation and performance, Erin Cook.

The initiative is not unrelated to the lessons of the pandemic, which has lifted the veil on the low hospital capacity of health establishments and the need to review the organization of work due to the shortage of manpower. ‘work. In the midst of the Omicron tsunami, the JGH deployed the “COVID at home” project, which allowed employees on protective leave to monitor patients with the virus at home.

Extended experience

Equipped with a body sensor, the patient could be monitored remotely. With the arrival of the sixth wave, the JGH has continued its project, but now wishes to push its concept further by trying the experiment with patients suffering in particular from heart failure, pulmonary diseases, pneumonia, infections of the urinary tract or cellulitis.

The establishment even begins to select patients as soon as they are admitted to the emergency room, which avoids their hospitalization altogether.

“We do not need 100% of patients to be eligible for this, we do not dream in color”, supports the president of the Federation of medical specialists of Quebec (FMSQ), the D^r Vincent Oliva, who supports the project.

The FMSQ wants to put forward this new concept which could thus “improve” Minister Christian Dubé’s Health Plan. “The technology is there”, pleads the D^r Oliva in interview.

How it works ?

The eligibility of each patient is assessed according to the protocols developed for this project. He must be stable and able to count on the help of a caregiver at home. The latter is also evaluated so that he is able to carry out the necessary follow-up. The establishment makes an electronic tablet and technological support available to the patient.

“Virtual care is provided 24/7 by nurses who continuously monitor vital signs, who organize virtual meetings with the patient”, illustrates M.^me Cook. A user can receive up to three or four virtual visits per day. The home care team can also be involved if the patient needs face-to-face care.

It is also not impossible that the patient must return to the hospital depending on the evolution of his condition.

“In medicine, 80% of the assessment is talking to the patient,” says JGH Cardiology Chief Dr.^r Lawrence Rudsky. Of the 22 patients who have taken part in the experiment so far, only 2 required the displacement of a home care team.

It is still too early to estimate what proportion of the number of hospitalized patients could be followed at home, according to the JGH. In Boston, for example, establishments have set the target of patients to be cared for remotely at around 10% out of 2,000 beds.

So far, such initiatives have been rolled out in Alberta and British Columbia. Ontario also had a COVID-style project at home.

Catching up with technology

According to the FMSQ, Quebec must catch up in health technology and welcomes in this sense the greater place that the Legault government wishes to give to telemedicine, which has experienced a boost with the pandemic. “I think that in 10 years, there is a lot of medicine that will be practiced in a different way, in a virtual way with care that is brought to the patient and not the reverse”, supports the D^r Olive.

Sweet words in the ears of Christian Dubé, who believes that this concept “checks several boxes” of his Health Plan. He will mandate Deputy Minister Lucie Opatrny’s teams to monitor the pilot project and determine if it can be replicated elsewhere in the province. “Quebecers want to be cared for at home, that’s what they want,” he said in an interview with The Press.

“This project is part of access to the first line, in innovation, in the [virage vers les] home care,” said the minister. It is also in line with its objective of improving “hospital fluidity” in establishments by creating emergency command centers. That of the JGH is also cited as an example in its “refoundation” plan.