Building hospitals without walls
Our idea of what hospital care means has not changed for centuries. People come to a hospital to seek help and have their identities transformed to a patient in uniform, assigned a ward and bed number, where they live until they feel better. Patients must be in hospitals, because they require frequent medical reviews, round-the-clock nursing, intravenous therapies or frequent blood tests. As our population ages and the frail and multimorbid elderly increase, our acute hospitals are under intense pressure to provide more wards and more beds.
In the era of Deliveroo, Grab and NinjaVan, what if acute hospital care could also be delivered to the comfort of your home? ‘Home Hospital’ programmes challenge the traditional notion of inpatient care by suggesting that a selected group of patients currently cared for in hospitals can instead receive this care in their own homes, while maintaining standard of care and cost. MOHT is partnering various stakeholders to describe, develop and evaluate such a programme.
Under the ‘home hospital’, patients who are acutely unwell and would need hospitalisation will receive hospital-level care at their own homes, via home visits by healthcare professionals assisted by remote diagnostic, monitoring, communication and treatment modalities. During their stay, patients will be regarded as inpatient cases (in a “virtual ward”) guided by care protocols and remain under the oversight of a designated doctor / care team until they are fit for discharge.
HaH can provide a substitute to hospital care for selected patient segments¹
The model was first described in detail by Professor Bruce Leff from the John Hopkins School of Medicine in 2005.
Follow-up research demonstrated that the home as a site of acute level care has many benefits for appropriate patients, including improved sleep, increased mobility, improved recovery rates, reduced fall rates, higher patient engagement levels, reduced delirium incidence, reduced use of physical or chemical restraints, reduced use of sedative medications, and high levels of provider satisfaction with the model.
Since early 2010s, there has been growing interest in its potential and implementation in various matured healthcare systems worldwide.
Home hospital programmes in Australia substitute up to 5% of bed days, but in compact urban Singapore, it could be much greater. There are 3 key enablers required for this to become a reality. First, healthcare financing must treat home hospitalisation as no different to ward hospitalisation, allowing equivalent subsidies and insurance coverage such that it is cost-neutral or cost-saving to patients who select this option. Second, patients’ mindsets must shift from a traditional view of hospital as a ‘safe haven’ to having their home as an attractive alternative site to receive this care. Third, a pool of healthcare professionals must be trained in delivering this care, including competencies such as generalist medical training, interpersonal skills with patients and subspecialty colleagues, leadership of multidisciplinary care teams and health technology including managing and developing digital health systems.
Similar sets of technology enablers and care delivery models can be applied to other use cases along the entire care continuum. With the possibilities, MOHT is adopting a multi-pronged, multi-stakeholder, multi-site approach to a series of hypotheses testing and care model validation. Findings from every pilot at every site will seek to contribute to a larger picture and eventual understanding of the full potential of HaH implementation in Singapore.
Lai Yi Feng is a Project Manager within the Integrated General Hospital programme, and holds joint appointments as a Pharmacist with Alexandra Hospital, as well as an adjunct lecturer with National University of Singapore. He is a fellow with the International Society for Quality in Health Care (ISQua) and has authored more than 15 peer-reviewed publications with topics ranging from public health to clinical practice innovation.
 Vector images in the infographic created by pch.vector (www.freepik.com)