The emergency departments of The Ottawa Hospital are often packed with patients suffering a range of conditions. Some require immediate medical attention. Others, without a regular family doctor, were there for prescription renewals or medical updates.
Amid mounting pressure on the ER, and the general shortage of family doctors, The Ottawa Hospital recently started Ontario’s first “Hospital at Home” program.
The program is meant to “ease pressure on hospital resources while ensuring timely, high-quality treatment,” especially for patients who would otherwise wait in the emergency department for a bed to open up, said a press release from hospital spokesperson Rebecca Abelson. It is being run through a partnership with CBI Home Health, a private home care service.
Patients wait in the emergency room for an average of 20.8 hours at the Civic campus of The Ottawa Hospital and 23.7 hours at the General campus before being admitted. And it can take several hours to even be assessed by a doctor.
Chart shows average wait times to be assessed by a doctor at all Ottawa Hospitals. Four exceed the provincial average [Source: Health Quality Ontario. Graphic @ Gabriella Rodrigues]
Hospital at Home is designed for patients who are sick enough to need hospital-level care, but stable enough to be treated at home. Instead of being admitted to an inpatient bed after an emergency visit, they are admitted to a “virtual” unit and return home. They remain hospital in-patients on paper.
It provides a way to give acute medical care to patients in the comfort of their own home without having to build brick and mortar buildings.
Dr. Krista Wooller, chief of internal medicine at The Ottawa Hospital
Dr. Krista Wooller said she has seen positive benefits in the short amount of time she has worked in the program.
“It provides a way to give acute medical care to patients in the comfort of their own home without having to build brick and mortar buildings,” the chief of internal medicine at The Ottawa Hospital told Capital Current.
Wooller said care improves because patients feel more comfortable sleeping and eating in their own homes. She said the most “striking” aspect of the program is that nurses are able to provide the care patients need by observing them in their home environments.
She explained that the program uses a mix of daily in-person and virtual appointments, typically with a nurse visiting the patient’s home daily to draw blood, administer medication and conduct other tests. The hospital supplies patients with devices such as a blood pressure cuff and a machine that measures oxygen and heart rate so the patient can be monitored virtually.
“It provides a way to give acute medical care to patients in the comfort of their own home without having to build brick and mortar buildings,” Wooller says.
Valérie Dubois Desroches, senior vice-president of patient care at Hôpital Montfort, said the hospital is considering the home model, which is “aligned with our priorities in terms of continuity of care.”
She says Montfort has adopted similar initiatives such as “telehealth” and “virtual care,” and that these provide a “solid foundation” to support patients for a potential Hospital at Home program.
The program has been successful at addressing bed availability in Vancouver at Island Health, a network of hospitals which opened Hospital at Home programs at the Victoria General Hospital in 2020 and at the Royal Jubilee Hospital in 2021. Data from Island Health showed that the program saved more than 19,777 days of hospital beds.
Dr. Shauna Tierney, a family doctor who leads the Hospital at Home program at Island Health in Victoria, said one of the great benefits of the program is the ability to rapidly create more hospital beds at a fraction of the cost. Since then, the model has grown across British Columbia. A provincial update in August 2024 reported seven Hospital at Home programs.
Dr. Sean Spina, pharmacist and lead researcher of the Hospital at Home program at Island Health, says patient-focused research is important to developing the program. During a research period of 18 months at Island Health, Spina and his team found that 98 per cent of patients and caregivers said they would participate again in the program.
“To be honest, I do see Hospital at Home being the future of health-care delivery for a certain subset of patients,” he said.
Tierney said the program has taken pressure off emergency rooms in Victoria by freeing up about 17 beds per month. She said patient outcomes are better, as people being treated at hime are less likely to be readmitted to the hospital and suffer complications from hospitalization such as infections.
“I am of the firm opinion that HaH should be standard in every hospital,” she said. “It provides better care for patients who meet its eligibility criteria compared to traditional care on the hospital ward.”
Tierney said she is “delighted” that the program has expanded to Ottawa.
Dr. Jonathan Dick, who leads the Hospital at Home unit at Providence Health in Victoria, said he often treats eligible patients with conditions such as pneumonia, heart failure symptoms, cellulitis or kidney infections through the program.
He said there are challenges in implementing the program. One is figuring out communication between health care providers who are visiting the patient at home and providers who stay at the hospital.
“Certainly just building up a strong team, takes a few months to figure out who’s the right doctor, who’s the right nurse to participate in this program. It’s not for everybody, I would say.”
Spina said one of the most important things as the Hospital at Home program grows is to collaborate across Canada, even though B.C. has more established programs.
“There’s stuff that we could learn from Ottawa that they’re going through and experiencing, to be quite frank, so I don’t think it’s a one-way what they can learn from us,” he said. “It’s more of what can we learn from each other as we collaborate across the country and look at trying to develop and define a new model of care for patients.”
