The objective of the project is to offer well selected patients to move out of the crowded and expensive hospital wards earlier than usual. Treatment and care for these patients is supplied in their own homes by a hospital based advanced team of pediatricians and specialized nursing staff using modern techNology and management support. The strategy has been conceptualized into an integrated framework built on elements presented in figure 1. Each part is developed as a separate project using information techNology and telemedicine as work tools in order to enable the creation of a “virtual hospital” concept. The projects are sponsored by public as well as private funds and involve specialists from industry and technical universities.
1. The project at Karolinska Hospital introduces the "virtual hospital" into the patient's own home. The work is managed from a control center which co-ordinates the activity of the mobile teams in relation to patients/parents and hospital wards. The mobile teams are equipped with mobile phones, mobile computers and are using cars. Equipment and software for monitoring and interacting with patients in their homes from the control center is currently in pilot status or under development. Digital camera pictures are transmitted to the control center, and future interactive video consultations will be an option. A current problem is the lack of generally available broadband data communication options – the infrastructure in the society, as most of our patients require care for only a short care time, on average less than a week.
Extensive research and development has been devoted to obtain a model for planning of resources and logistics, where even advanced computerized simulation and optimizing tools are used.
For enhanced logistic planning purposes a geographic information system is being developed to indicate the location of patients related to transportation resources and available staff. Initially transport car location is automatically given by an advanced GSM based GPS system. For the future the location of mobile staff will be automatically monitored based on the same GSM/GPS system integrated into their personal mobile phones.
The project has been approved as one of four projects within the advanced home care area to be supported by the European Commission 5th Framework IST Programme. Within this telematic home care area the project will test and demonstrate wireless microsensor techNology for continuous patient status monitoring.
A mobile computer-based system for planning and documentation of medical and nursing care is also under development. An interactive database has been developed for registration of patients, medical activities, staff involvement, use of resources and time spent on various assignments. This enables quality control and on demand adjustment of scheduling and assignment of personnel.
2. Care Procedure Patients accepted are ex. newborn infants with congenital malformations. Post neonatal care of prematurely born infants with need of oxygen therapy and nasogastric tube feeding. Children with acute diseases ex. severe burn injuries, severe pneumonia, osteomyelitis. Post surgical care. Multi-handicapped children with acute complications. Failure to thrive. Oncological patients under treatment. Terminal care.
The criteria for admission are several. The patient’s condition must be under control and treatment in their home must be medically safe. The alternative treatment would be at a ward at the specialist hospital. Patients/parents written consent for homecare is required. The family must have the possibility to manage care of the patient at home. The patient can’t live too far from hospital, a maximum drive of 30 minutes is settled.
The medical staff consists of two pediatricians, 10 pediatric trained nurses, 10 child's nurses and one almoner. The work is organized in 24 hours care. The capacity of the home care unit is about 15 patients every day and night.
The cost per day for the treatment is on average halved compared to traditional inpatient cost, while at the same time the medical quality and expressed patient/family satisfaction has been recorded as very high.
Initial project planning has been supported by quality control model based on the Clinical Value Compass: Clinical outcomes, patient descriptors also includes patient satisfaction, functional health assessment, financial data— measures lengths of stay, costs, and reimbursements.
An interactive Internet environment is used to support the project development process.
Quality: SABH has become an integrated part of the highly specialized pediatric clinic at Karolinska Hospital, that is available for the family on request.
Patient –parent satisfaction: SABH has made it possible for sick children to return home sooner and hereby improve their health status. It also enables the family to resume Normal life style. A questionnaire has been sent to the first 100 patients/parents.
EcoNomy: the creation of SABH has increased the capacity of the pediatric clinic with aNother ward (13- 17 beds). The cost per bed is less than half of the cost of the traditional bed at the hospital. Having a child in SABH is beneficial for the family ecoNomy compared to traditional care in hospital. A cost/benefit analyzes has been made.
The medical staff has shown great satisfaction in creating this new concept as they see the benefit for the children and the parents and further training for themselves. The medical staff has been interviewed during the project.
SABH has become a demonstrator for an “Open or Virtual Hospital” concept.
The acronym SABH stands for Hospital Managed Advanced Care for Children in Their Homes (Sjukhusansluten Avancerad Barnsjukvård i Hemmet in Swedish).
It is a well-kNown fact that hospitals as such don't provide the ideal environment for treating sick children. Based on an "open hospital" concept, the Astrid Lindgren Children's Hospital - the pediatrics division of the Karolinska Hospital in Stockholm, Sweden, - has developed a solution for treating sick children in their homes.
The patients treated are children that would under traditional circumstances have been treated in a ward at the specialist hospital, and thus SABH is an integrated part of the inpatient specialist hospital. The initial phases of the project started in 1996 and the first pilot patients were admitted in November 1998. During 1999, 313 inpatient episodes have been registered and about 3000 nights spent in bed at the patients homes supported by the SABH mobile teams. Days and nights that without the SABH project would have been spent in a hospital bed.
Dedicated staff, re-engineered thinking and inNovative techNology support enabled by mobile communication and the Internet have enabled this.
To ensure quality and efficiency a lot of attention has been placed on developing organizational structure, processes, procedures, logistics and techNology support. For process development and quality improvement the "Clinical Value Compass" methodology has been used, and the MedModel computer simulation tool has been used to develop the logistic model.
The SABH project shall be considered both a R&D medical process and methods project and a demonstration project for new ways to support home care and to provide secure and good living conditions for other patient groups, disabled and elderly people in their homes.
The SABH project participates in the European Commission 5th Framework Programme of European Research as a partner to the TelemediCare project. Within the project the SABH will explore and validate emerging techNologies and solutions for workflow management and coordinated planning across traditional organizational borders and associated distributed medical processes.
The TelemediCare project also addresses a scalable telematic environment to be used in the patient home and micro sensor wireless techNology to allow for continuos monitoring of the patient health status.
A video presentation is available to illustrate the project.
Bo Lundell , Chairman of Steering Committée, Karolinska Sjukhuset (email@example.com)
Margareta Fagerberg, Project Manager, Karolinska Sjukhuset
Emma Rylander, M.D. Ph.D., Head of Department, Karolinska Sjukhuset
Helena Bergius, Head-nurse, staff coordinator, Karolinska Sjukhuset
Ulf Jacobsson, Telemedicine solutions integrator (firstname.lastname@example.org)
Yrjö Palmqvist, Senior Advisor - Telemedicine, Stockholm County Council (email@example.com)
Annika Eng, Project Administrator; Tieto Enator Trigon (firstname.lastname@example.org)
SABH Astrid Lindgren Childrens Hospital, Karolinska Hospital
S-171 76 Stockholm, Sweden
Phone: +46-8-517 77092