Northern Region Hospital at Home reaches 120 daily patients

NEWS - eHealthNews.nz editor Rebecca McBeth

The Northern Region's Hospital at Home (H@H) programme is supporting around120 patients daily, with plans to expand to 200 patients by the end of the next financial year.

The service is having a significant impact on hospital capacity by effectively freeing up around 80 beds daily across the region's hospitals.

The home-based service combines continuous remote monitoring using wearable devices, intermittent monitoring devices, virtual ward rounds and in-person interventions, with 60 percent of patients on any day receiving in-person interventions and 40 percent of patients receiving virtual care as an alternative.

Erik McClain, clinical lead Northern Region H@H, says that since launching at Auckland Hospital they have seen a reduction in general medicine length of stay by one day.

With those wards seeing up to 220 patients daily, shaving a day off length of stay has a massive impact, he says.

Counties Manukau was the first to develop and implement H@H pathways supporting admission directly from the Emergency Department (ED) Medical Assessment Unit. Half of all patients admitted to H@H in Counties Manukau now come directly from the ED, avoiding a hospital admission altogether.

Other sites are planning to implement similar direct admission routes within the next few months. 

As the three Metro Auckland districts, H@H services were developed rapidly in response to the challenges created by the Covid-19 pandemic and in 2023 the Northern Regional Provider Group tasked the region as a whole with expanding H@H services.

Te Tai Tokerau went live with their first patients in March 2024, completing the regional rollout.

Penny Magud, interim regional operational lead for Northern Region H@H, says a key component of the regional service is the 24/7 virtual coordination hub staffed by virtual care nurses who monitor patients using remote wearable devices and intermittent monitoring equipment. 

The digital technology enables the service to support more patients, including those with higher acuity, through 24 hour oversight and virtual vital sign monitoring.

The wearable currently being used by H@H allows the team to monitor six different vital signs (HR, BP, RR, SPO2, Temperature and ECG), along with cardiac algorithms. A virtual care dashboard operates 24/7, prioritising patients based on early warning scores generated from their vital signs data.

"All patients receive virtual care as part of the hybrid model of care, as each patient is reviewed in a virtual ward round each afternoon, which are led by our H@H clinicians (SMO/Nurse Practitioners) ” Magud explains.

“This winter we are aiming for 150 patients at any given time to be supported in H@H across the region, with a vision that by end of the 2026-2027 financial year we will be supporting around 200 patients on any given day of the week”.

McClain says the programme has expanded beyond general medicine to include post-operative cardiothoracic surgery patients, with plans to add pre and post-operative vascular patients. New pathways from the ED for cardiology and general medicine patients admitted directly to H@H go live next month.

Future developments include bringing patients from Northland and Waitematā to Auckland for surgery, with pre and post-operative care provided through H@H. 

Caroline Ogilvie, project manager for digital delivery Northern Region Digital Services, says the team is working on sponsored data arrangements to ensure patients can access the service without the cost of data being a barrier.

"The patient can directly text or call the virtual care hub and also the virtual care hub can directly contact the patient by video call/ SMS/ in app messaging and push educational materials and patient questionnaires," she says. 

Patient satisfaction is high, with net promoter scores reaching 98-99 percent against a target of 90 percent, Ogilvie adds.

The Northern Region has had more than 7,000 admissions to Hi@H over the 12 months with nearly two thirds of patients over 70-years-old.

Magud says the programme reflects the area’s diverse patient population. Around 18 percent of H@H patients identify as Māori, 33 percent as Pacific peoples and 18 percent as Asian.

Image: Erik McClain, clinical lead Northern Region H@H

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