Organization - Hospital at Home Service

Clínic Barcelona Cross-sectional Hospital at Home has two modalities of care to better meet the needs of our patients: Hospital at Home itself, which represents more than 90% of the activity of our Unit and Home Day Hospital.

Hospital at Home (HaH) is an alternative for patients with medical and surgical conditions who require hospital admission. Patients are admitted to HaH from the Emergency Department or the different hospitalization units. It is a time-limited care model, which provides hospital-level care at patients' homes by Hospital health professionals.

What are the admission criteria?

• Any patients with conditions that require hospital admission and that, according to the criteria of their physician in charge, may be good candidates for hospitalization at home.
• Patient living in the Barcelona Esquerra area. In selected cases, patients from the rest of Barcelona city, or even outside Barcelona who temporarily stay in our Hotel “Salut”, can be treated.
• To live in a home with adequate hygienic and environmental conditions and a telephone line (landline or cellular) that allows the care team to contact continuously with the patient, and viceversa.
• The patient must be accompanied by a family member and / or caregiver during admission to home. In patients with a high level of autonomy, this criterion should be assessed individually.
• Previously to admission to HaH, both patients and their caregivers or his legal representatives must agree and sign an informed consent document.

In what cases can this service be offered?

• Patients at the Emergency Department that, after being assessed and treated, their medical team decides that they should be admitted to the hospital, but that they could be treated equally at home.
• Inpatients admitted to a hospital bed, who show clinical improvement and are stable enough to complete admission at home.
• Patients who are visited in Outpatient Clinics, the Day Hospital or in Primary Care, who require admission and who, due to their health status and conditions, can do so at home.

What is the HaH admission process?

In the hospital:

• The team who care for the patient in the hospital assess whether they can benefit from the HaH service. The decision is shared with the patient/family and with the HaH team.
• The HaH team performs a global assessment of the patient to ensure that the treatment and follow-up are personalized and that the process can be treated safely at home.
• After having accepted admission at home, the transfer process begins, as well as the preparation of the treatment and the management of the equipment that the patient needs at home.
• Both the patient and his or her caregiver have all the information and a contact telephone number to contact directly with the HaH team.
• The patient is transferred by ambulance at home, accompanied by his/her treatment plan and an information sheet with team's contact telephone number.
• Once arrive at home, patient will receive a first call from the HaH team to check that he or she have arrived home safely, to address doubts with medication and / or other problems. Patient is also informed of the schedule of home visit that will take place during the next 24 hours.

At Home:

• Daily visit of the nursing team, during the morning and/or afternoon
• Medical visit whenever necessary (between 9am and 5pm) and at the time of discharge
• Direct dial phone to contact with the HaH team
• The tests and procedures needed by the patient (blood/urine sampling, EKG, wound cures, ...) will be carried out at home whenever possible. If a certain test cannot be done at home, patient will be taken to hospital by ambulance and then returned home for treatment.
• Discharge is given from home, after contact with primary and community care teams to ensure continuity of care.

What does it consist of?

The Home Day Hospital is an alternative for patients with medical and surgical illness who require hospital-level care at home. These are processes that do not require hospitalization. The Home Day Hospital attends to patients who come from the hospitalization rooms, Day Hospitals and Outpatient Consultations. HdH team coordinates with community teams.

What are the criteria?

• Living in the Barcelona Left area. In some very selected cases, patients from other districts in Barcelona City can be attended
• Have a contact telephone number
• Patient agreement through an informed consent document

In what cases can this service be offered?

• Complex treatments at home, i.e.: mechanical ventilation at home, nebulized antibiotics, hospital dispensing treatments or parenteral drugs.
• Patients with severe disease tributary to transplantation and/or other surgical treatments with mobility problems.
• Patients who at the time of hospital discharge require specialized care at home.
• Complex care at home in patients with mobility problems.

What is the process?

• Direct telephone to talk to the health team
• Periodic nursing visits
• Many tests may be made at home and, if they can't be done at home, patient is taken to the hospital you for testing and then returned home.
• Patient is discharged from the HDH program when he or her no longer needs hospital follow-up, so the community team is contacted to ensure continuity of care.

Hospital at Home is a good example of a more patient-centred approach, and it is essential to have tools to measure the outcomes of home hospital care.

As an alternative to conventional hospitalization, we must always guarantee a care equivalent to that provided within the Hospital. That is why it is so important to advance in the management of the Quality and Clinical Safety of HaH services.

In 2023, the HaH service has obtained the double ISO 9001:2015 and UNE 179003:2013 certification for Clinical Safety, being the first HDOM service to obtain it.