Hospital in the home innovation recognised.

MIDCENTRAL DISTRICT Health Board's (MCDHB) Hospital in the Home (HITH) programme, a service that is dependent on the work of district health nurses, won the organisation category in last month's inaugural Health Innovation Awards.

Presented at a ceremony at Te Papa in Wellington last month, the awards were organised and funded by the Ministry of Health and the Accident Compensation Corporation. The HITH service was one of 192 entrants, all of which, organisers say, produced ideas that can be transferred to health providers around the country and even internationally. The group category winner and the supreme award was won by the Wellington Independent Practitioners' Association for its free retinal screening service for diabetics, while the individual category award went to physician Malcom Battin from National Women's Hospital and the Liggins Institute for an infant's cooling cap that may prevent a baby's brain from developing brain damage in the days after birth.

MidCentral's HITH service has created "virtual hospital wards" that deliver specialist medical and nursing care for seriously ill patients--especially those at high risk of infection--in the privacy and comfort of their own homes. The service was one of 25 finalists in the organisation category and has been described by MCDHB's infectious diseases' specialist Richard Everts as "the jewel in MidCentral Health's crown". Virtual hospital wards have been operating at MidCentral for the last three years and were an initiative promoted by emergency department and district health nurses. To date, 450 patients have become external inpatients, remaining under the supervision of a MidCentral DHB specialist medical practitioner, with their care provided by the district nursing service.

One of the chief drivers of the concept, clinical nurse specialist for community services, Chiquita Hansen, says when the service started, it was proposed only five patients a month would be cared for in this way. Numbers have now grown to around 26 per month, with up to 14 patients a day part of HITH. Care is provided for a range of diagnostic groups including well patients with neutropenia, patients with cystic fibrosis who require complex intravenous therapy, and women experiencing hyperemesis. The most complex care given to date was for a patient requiring eight-hourly IV antiemetics, pain management support, 16-hourly total parental nutrition infusions, 16-hourly enteral feeding and daily abdominal wound care. The service is continuing to develop new ways to treat a wider range of conditions in the community and is currently investigating options of care for patients with congestive heart failure, working in partnership with local iwi providers and rest-homes.

The service is based on the premise that health care and treatment provided in the patient's home could be, at least for certain conditions, similar or better than that provided in hospital. Patients are protected from hospital-acquired infections, while at the same time patients with infection keep their infection at home, rather than bringing them to hospital to be shared with other patients and staff. This has meant reduced pressure on isolation rooms and has assisted the DHB with bed management issues.

Hansen believes the key to the service's success is the comprehensive, 24-hour, seven-day-a-week service provided by district nurses. Prior to the development of the HITH service, district nurses were already providing specialised post-discharge nursing care, which included acute care for patients requiring IV antibiotics for noncomplex conditions. With the establishment of HITH, district nurses undertook a great deal of inservice training to update their acute nursing skills and develop their standards of practice. Being able to use acute nursing skills in the primary care setting has led to an increase in district nurses' job satisfaction.

"We have become a resource for other DHBs and are now considered to lead the way in providing complex care in the community setting," said Hansen.

Another key to the service's effectiveness is the work of a multidisciplinary team of health care providers, including medical specialists, clinical nurse specialists, pharmacist, occupational therapists, physiotherapists and social workers.

Feedback from patients about the service has been very positive, with 94 percent surveyed to date giving an "excellent" rating for their involvement in planning and provision of their care.

Hansen says the $8000 award will be used to identify further patient groups that would benefit from the service and to encourage research. MidCentral DHB is planning to hold a celebration of the award this month, with special recognition for the key role of the district nurses.

Other awards

Other highly commended awards went to a Hokianga project to improve drinking-water quality for 31 marae and two communities, using a specially developed filter system; Te Rau Pani kaupapa mental health service, New Plymouth; the nurse-led diabetes clinic at Paraparaumu College; a GP-staffed skin lesion service at Waitemata District Health Board; and Meg Butler for her high tech bodywear for hip protection garments for older people.