Bringing the hospital to the home
Cloe Benz piloted the use of virtual treatment delivery, which was the first service in New South Wales to actively treat acutely unwell patients at home via telehealth. Here she talks about the Hospital in the Home program with Skye Mitchell.
The Hospital in the Home program is a community acute and post-acute care service operating at the Sydney Children’s Hospital and The Children’s Hospital at Westmead. Some major tertiary paediatric hospitals have a variation of the public health service but the concept is still relatively new.
Senior physiotherapist with the Hospital in the Home service, Cloe Benz, says its aim is to provide care equivalent to what children would receive in a hospital in a ward, but in their own place of residence or close to their home. The program works to ensure that paediatric patients receive the best care while also being able to have the highest quality of life possible.
‘We try and integrate ourselves into their daily life,’ Cloe says. ‘We get involved a bit earlier than the traditional hospital model might and we aim to get children better sooner, and in turn, they won’t need quite as much intervention. For example, if you catch someone who is going downhill and becoming unwell and you start a proactive treatment model with Hospital in the Home, then they’re less likely to end up in a ward bed requiring oxygen or requiring significant intervention.’
Before she began working within the Hospital in the Home service, Cloe worked in an inpatient team in the intensive care unit but wanted an opportunity to see children when they were a bit happier, and where she could interact with them in a more positive way.
'We take on any patient who is referred to us and is safe to be at home.'
‘I was really looking to find an opportunity to work in an acute setting and be challenged by lots of different types of patients, but also to really get to know the patients and interact with them and their families,’ Cloe says. ‘It’s a really nice feeling, especially when we are able to help the parents … there’s a lot of parental anxiety, especially for parents of kids who are quite sick.
‘Sometimes we take kids home who have been very unwell, who have had fractures or are oncology patients, or kids who have been born in hospital and never gone home for the first six months of their life. It’s a really big thing for the parents to then take their kids home and be able to look after them and feel supported by our service.’
The Hospital in the Home team at the Sydney Children’s Hospital has both nursing staff and physiotherapists, and when necessary, includes social services and ambulatory care services.
‘Basically we function like a ward, having a bed board as if the patients were inpatients, and we see our patients as frequently as they would be seen on a ward. The only difference is that they’re actually at their homes. We have a few criteria they need to meet before they can go home,’ Cloe explains. ‘We need to have the children deemed medically stable before they go home. Hospital in the Home patients also need to live within an hour’s drive of either one of our hospitals or they need to be able to stay at accommodation closer to the hospital.’
The main aim of the service is to provide multidisciplinary care so that a patient’s condition can be managed in an environment more familiar to patients and less disruptive to normal day-to-day routines for families. Patients with a range of debilities can be treated remotely such as cystic fibrosis, neuromuscular conditions, oncology rehabilitation, and post-orthopaedic surgery, to name few.
Cloe says ‘we are a seven-day-a-week service. We run from 7.30 in the morning to 9.30 at night. I think it’s a really great opportunity for kids who spend a significant period of time in hospital to be able to access these services but not have to be in a ward bed on hospital grounds. It also helps a lot with the pressure of having isolation rooms for kids with different bugs, and all sorts of other hospital logistics that come with being a big tertiary hospital.’
With the demand increasing for hospital health services across the Western Sydney Local Health District, the Hospital in the Home patient load is at full capacity at least 80 per cent of the year; therefore, as soon as extra staff come on board, the program is expanded to take on more patients. Cloe says although the program is expanding, patients need to be assessed for suitability on a case-by-case basis.
‘Sometimes patients will need extra services such as social work or psychology input, and sometimes they need a bit more extra care from the physio. We can’t provide three-times-a-day physiotherapy, but sometimes that is what they need. We take on any patient who is referred to us and is safe to be at home.’
Cloe’s innovative attitude to her work as a physiotherapist led her to share, earlier this year, how paediatric physiotherapy using telehealth can be achieved—at the foremost health information and technology conference, HIMSS Global Conference and Exhibition in Orlando, USA.
‘I think over the next 10 to 15 or 20 years it’s going to increase as the demand for hospital services increases and the space for hospitals doesn’t increase at an equitable rate,’ she says. ‘We have to be able to cater to our patients, and one of the ways that the system is looking at responding to that is investing money in services like Hospital in the Home.’
Cloe Benz is studying a master’s of paediatric physiotherapy through Monash University to research the implementation of telehealth in the acute care of paediatric respiratory patients. Her clinical care experience spans across the three major children’s hospitals in New South Wales and includes intensive care paediatric, ward care, outpatient and community positions.
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