HITH: Concept and clinical guidelines

Hospital in the Home (HITH) is the provision of hospital care in the comfort of the persons own home. In this patients are regarded as hospital inpatients and remain under the care of their treating doctor in the hospital, they receive the same treatment that they have been received in a hospital bed. Patients may be able to receive all their hospital care in HITH. Participation in HITH is voluntary - patients and their carers must agree to have their care provided at home. There are no additional charges to patients for being in HITH and it is available to public patients from the 43 participating public hospitals across the state.

HITH: Concept and clinical guidelines

Shweta Kapoor^*, Satyaendra Shrivastava,Darshan Dubey  

*  Correspondence 
    Columbia college of pharmacy, Tekari, Raipur, 07721266302 
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Abstract

Hospital in the Home (HITH) is the provision of hospital care in the comfort of the persons own home. In this patients are regarded as hospital inpatients and remain under the care of their treating doctor in the hospital, they receive the same treatment that they have been received in a hospital bed. Patients may be able to receive all their hospital care in HITH. Participation in HITH is voluntary - patients and their carers must agree to have their care provided at home. There are no additional charges to patients for being in HITH and it is available to public patients from the 43 participating public hospitals across the state. A wide range of conditions and treatments are provided in HITH, the most common are intravenous antibiotic treatment of cellulitis, genito-urinary tract or respiratory tract infection, anticoagulant therapy and chemotherapy. This is totally a new concept for treating patient, which gives more satisfaction to patient as compare o hospital treatment. This paper tries to attract the attention of hospitals, doctors and nursing staff by including its details and required clinical guidelines.

Introduction

HITH is probably best established through a stand-alone unit within the hospital, with its own budget and staff. It has its own technologies, such as computerized pumps and peripherally inserted central catheters and is skilled in the use of pharmaceuticals at home. It has its own body of research, it is expert at assessing people for acute home-based care, with involvement of experts. It accepts patients from all other hospital units, services and disciplines. It is therefore a dangerous attribute in a modern hospital environment yet it is rapidly accumulating its own core of specialist knowledge. It is able to embrace specialist requirements through direct staffing of nurses with appropriate experience, or through the education of current staff. It is developing specific standards that will allow improvement in quality and benchmarking. HITH units should have nurse-administered, medically supervisor and attended care. Twenty-four-hour nursing and medical telephone support, with the ability to visit after hours, is mandatory. There should be clear lines of clinical responsibility and continuity within HITH, and proper link to the hospital and between it is requied. Even with all of these inputs, HITH will still offer care equivalent to traditional hospital care at a lower cost^1,2. Future studies of hospital, HITH patients, examining costs and quality-of-life measures will acknowledge the additional advantages of HITH care. At present, the healthcare interventions suited to HITH are intravenous therapy of all types (including antibiotics, antifungals, antivirals, some chemotherapeutic agents, corticosteroids, inotropes and blood products) and acute anticoagulation. Acute rehabilitation, insulin initiation and some complex wound care are also included in some HITH programs. Although new applications will be found, it is important that HITH should adhere to the demonstrable substitution of hospital inpatient care and not establish intermediate care programs or duplicate current community services. To prove the efficacy and safety of HITH system several studies has been carried out. For example in Victoria hospital (Australia) in the home programme a survey was carried out to determine the satisfaction of a group of patients and carer. Sixty seven (67) patients admitted to the HITH unit from Dec 1994 until the end June 1998. Almost all responsers i.e. 66 stated in an interview that they will like to use the service again if the opportunity arose³. Another study carried out in Christ church (New Zealand) to compare the efficacy, safety and acceptability of treatment with intravenous antibiotics for cellulitis at HITH unit and in hospital. Outcome came from above study revealed that not only treatment of cellulitis requiring intravenous antibiotics can be safely delivered at HITH unit  also patient’s satisfaction was found to be greater in patients who are treated in HITH unit⁴. This paper covers the HITH history, volunteers, benefits, working concept and clinical guidelines. So that the new concept can come in the knowledge of every one who is directly or indirectly dealing with public health.