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Patients with chronic, severe respiratory failure receive treatment through Long-Term Mechanical Ventilation (LTMV), mainly via mask-based ventilator therapy. This helps, for example, patients with lung diseases or neuromuscular diseases such as ALS.
The pulmonary department at Oslo University Hospital (OUS) has developed a program for LTMV at the Advanced Home Hospital (AHS) benefiting patients, healthcare professionals, and resource use. After a pilot project in 2019, the hospital is now in phase 2.
On day 1, the patient is visited by a nurse who provides training on the equipment. When night comes, the patient puts on the equipment.
On day 2, the nurse visits again, and the measurement data is transferred so the doctor can review the results. Then the doctor has a video call with the patient about the results, and any necessary adjustments are made to the machines under the doctor’s guidance.
Confrere was chosen as the video solution not only because it met security requirements, but also because it is simple enough to use so that patients do not need technical training or assistance.
On the left: one of the machines that takes measurements while the patient sleeps. On the right: successful testing of video calls on OUS’s own equipment.
In 2020, it was estimated that 250 hospital admissions would be needed for patients requiring LTMV monitoring. From 2007 to 2017, the prevalence more than doubled, and further increases in demand are expected: patients live longer, receive better diagnostics, and more have comorbidities.
This creates capacity issues for the Pulmonary Medicine ward (LUMS), which has 20 beds and an average of 8-12 admissions per week. Sometimes check-ups are postponed due to lack of capacity both in beds and nurses experienced with LTMV. The Advanced Home Hospital project helps address this.
Many of the patients have reduced mobility and may risk waiting for several hours in the hallway in a wheelchair together with their personal assistant. Sometimes ambulance transport is required, which is not always available on time.
The check-ups must be done while the patient is sleeping. Unfamiliar hospital surroundings lower sleep quality. Often, the hospital stay must be extended because the patient has not slept enough. By allowing patients to sleep at home, the measurements improve.
The Pulmonary Medicine Department has been treating patients with LTMV since the polio epidemics of the 1950s. Medical and technological advances in recent decades have made LTMV available to more patients, and in recent years telemedicine methods have also become available. This has made it possible to follow up with sicker patients at home.
Until 2019, a few patients were monitored and evaluated through home visits, but this was unsystematic and dependent on the goodwill of doctors and nurses. The idea to make the Advanced Home Hospital an ordinary treatment offer at OUS came from nurses and relatives and quickly gained strong support from the rest of the department and management.
An interdisciplinary project group consisting of doctors, nurses, and IT personnel developed the treatment offer. This was done in close collaboration with an expert group consisting of patients, relatives, patient organizations, the user committee at OUS, and representatives from Oslo municipality.
Both the patients and the expert group were very satisfied after the pilot. Patients who were in a stable phase of their illness and did not experience an acute worsening of respiratory failure preferred to have check-ups and treatment evaluations without being admitted to the hospital.
“At the hospital, it’s difficult to sleep. That’s the worst. It’s better to sleep in your own bed.” – Patient in the pilot project
The expert group highlighted safety, better sleep quality, higher quality of measurements, and improved quality of life as important factors. Additionally, the same proportion of measurements were successful at the Advanced Hospital homes as expected during regular hospital admission.
The project received a Diploma for excellent poster, voted by colleagues at the Medical Clinic research seminar in 2019. The project is also scheduled to be presented at the Research Days for nurses in Health South-East in March 2020 and as a poster presentation at the Health Services Conference organized by the Norwegian Institute of Public Health in 2020.
The team working on the Advanced Hospital homes at the pulmonary department at OUS.
In addition to patients and healthcare professionals being satisfied with the Advanced Hospital homes solution, there are also good socioeconomic benefits.
Patients avoid traveling to the hospital, which is often resource-intensive. Many are immobile and require, for example, a personal assistant or ambulance transport. For patients who are still working, hospital admission means lost workdays. Conducting check-ups at home therefore benefits patients in both good and poor general health.
Additionally, extra beds at the Pulmonary Medicine ward are freed up for other patients and emergency admissions.
LTMV at the Advanced Hospital homes reduces total costs compared to hospital admission, and costs for hired personnel are reduced.
The National Health and Hospital Plan 2020-2023 recommends increased use of home-based services, and this is also part of the development plan for Oslo University Hospital.
Unfortunately, the current financing system is not designed to cover the costs of such organization. The service can replace outpatient consultations but can also reduce the need for hospital admissions. The concept is relatively new, and it can be difficult to define home-based hospital services when they become so extensive and resource-intensive that they resemble an admission rather than an outpatient consultation.
At OUS, there is hope that the project with LTMV and the Advanced Hospital home can help modernize financing systems, benefiting patients, healthcare professionals, and resource use.
