Dr Joseph manages medically complex patient with Hospital at Home

"He was a medically complicated patient in his early 60s. He has high blood pressure, diabetes and is a renal transplant patient on immunosuppressant drugs," explains Dr Joseph. "An orthopaedic surgeon amputated four toes on his left foot because of complications related to diabetes. The post-operative site took long to heal and the patient said the wound was oozing a foul-smelling liquid. Because of this, the orthopaedic surgeon performed a debridement. Unfortunately, the patient continued to experience similar issues after this procedure."

• Debridement involves the removal of damaged tissue to help a wound heal.

"When the patient - who I've known for a long time - contacted me, I prescribed antibiotics, hyperbaric oxygen therapy and continuing wound care. Even with that, he carried on having issues."

"I recommended that the patient be admitted to hospital for a longer course of intravenous antibiotics and ongoing monitoring. But he wasn't keen to be admitted. One of his concerns was that because he is on immunosuppressants, he was more likely to pick up a hospital superbug."

• Superbugs are bacteria and viruses that are resistant to most of the antibiotics and medicines commonly used to treat the infections they cause. They are especially common in hospitals. Patients who are particularly susceptible to superbugs are those with open wounds, compromised immune systems and the elderly.

"Because the patient is a Discovery Health Medical Scheme member, I then suggested that we admit him to Hospital at Home."

• Hospital at Home is one of the first of its sort available in South Africa. It provides care in the patient's own home if the treating physician is comfortable with care at home. Patients are treated for a range of medical and post-surgical conditions that would otherwise require hospital admission. It is powered by integrated, cutting-edge technology and supported by highly skilled clinical staff. Visit our website for more information.

"Hospital at Home exceeded my expectations"

"Everything went well," says Dr Joseph. "Because it was the first time I used the programme, I expected to encounter issues, but it exceeded my expectations." "There was a qualified sister on site that monitored the patient, did frequent observations and checked everything on my behalf. She was on the ball and raised any concerns with me immediately. I communicated with the sister and the patient regularly through Zoom and WhatsApp calls."

"Someone was sent to the patient's home to do blood tests. The laboratory sent the results to me quite promptly and his medicine was delivered to his home. One of the medicines I prescribed wasn't available in Port Elizabeth, where the patient is based. Discovery Health contacted me and they managed to source the medicine from a pharmacy in Brits and couriered it to the Eastern Cape. It was there by the next morning. I thought that was great!" "The communication from the Hospital at Home team was superb and they contacted me regularly to find out how everything was going."

"From a doctor's perspective, using Hospital at Home was easy and convenient."

Benefits for the patient

"The initial plan was for this patient to fly to Gauteng and to be admitted at Unitas Hospital in Centurion, where I work. His wife would've travelled with him and there would've been all kinds of costs associated with their trip. So when I suggested we try Hospital at Home, he was really keen."

"The patient followed instructions and he responded extremely well to the treatment."

"He was in the comfort of his own home and his wife was right there with him while receiving hospital-level care and at less risk of picking up infections. If the patient didn't understand something, he would simply contact me."

"Hospital at Home has benefits for the patient in terms of cost savings, convenience, prevention of exposure to hospital-acquired infections, and good accessibility to doctors and physicians."

"I will use Hospital at Home again"

"I think that Hospital at Home is applicable to a specific type of patient. I could only manage this specific patient's level of care and complexity remotely because I've known him for a long time. I am familiar with his condition and how he responds."

• See the admission criteria for Hospital at Home.

"I definitely want to use the programme again and I have other patients who I think would be excellent candidates. For example, I normally admit my patients with autoimmune diseases like lupus two or three times a year to get intravenous cortisone and anti-inflammatories. That is something that can easily be done at home rather than in hospital. Even patients who have high blood sugar can be admitted to Hospital at Home, where they can still be monitored and treated."

"I think that Hospital at Home greatly improves access to doctors and specialists. In my practice, for example, there are patients who need to wait quite some time for an appointment. If they are very ill, I tell them to come to the emergency unit for admission. Depending on their condition, we can now consider Hospital at Home as an option."

Many positives to Hospital at Home

"I think the positives of Hospital at Home for the right profile of patient far outweighs the negatives. I would encourage other doctors who are on the fence about it to give it a try. Study the information on hand, get to know the system, identify the correct patient, and then give this service a try. You might be as pleasantly surprised as I was. You could find that it's something you can add to your care plans for specific patients to give you better exposure and accessibility to patients."

• Admit a patient through Hospital at Home.

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