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Last year's 5th Annual HITH Society Conference, held in Melbourne in November, was a great success. A number of local and international speakers were featured covering a broad range of topics impacting on the delivery of HITH services both here and abroad. If you missed the conference, or would like to review some of the presentations, a selection of sessions are now available for viewing at the HITH conference video website. Included is the complete session from Dr Jason Roberts who presented the findings from his pilot study comparing continuous infusion and intravenous bolus administration of beta-lactams in patients with severe sepsis.

Simply follow the link in the HPC Resources section to access the HITH conference video website.

One of the guest speakers at this year’s Annual Conference was Dr Jason Roberts, who has recently co-authored a paper on the Continuous Infusion of Beta-Lactam antibiotics for patients with severe sepsis. This pilot study is a valuable addition to the body of work already published looking at continuous Vs bolus administration, with its design also demonstrating viability for a larger study in ICU (and possibly other) patient groups.

Click here to watch a brief summary on the study

Keep an eye out for our next update for a link to the full presentation by Dr Jason Roberts

Managing ongoing education and training for team members can sometimes be tricky, particularly if your service is spread over a large catchment area. We have recently developed a “virtual” inservice video for the Baxter Infusor, which can be accessed at any time via The Home Calling Website. The video details some basic technical information on the Infusor, as well as best-management tips for nurses, patients and their carers.

Click here to watch the Virtual Inservice

Of course if you require any additional training or support materials for your service, please contact your local Pharmacy Services Sales Specialist, or call our One Call Medical Information service on 1300 302 409

In this latest episode of The Home Calling, we visit the fantastic staff of Liverpool Hospital's Continuum of Care unit to find out more about their program, and discuss the challenges of coordinating and delivering a hospital avoidance program.

Watch the episode online now.

Hot on the heels of the recent Deloitte/Access Economics report here in Australia, a study just published in the US also supports the potential of cost savings and increased patient satisfaction through greater utilisation on Hospital in the Home Services.

An innovative “hospital at home” acute care programme has reduced costs by 19% with similar or better clinical outcomes and increased patient satisfaction, an analysis has found. The programme combines daily home visits by doctors and nurses with telemedicine technology.

The ongoing programme at Presbyterian Healthcare Services in Albuquerque, New Mexico, was offered to those who met entry criteria, and a total of 582 patients (93%) enrolled between October 2008 and April 2012. It was adapted from a model developed at Johns Hopkins University.

“The savings were predominantly derived from lower average length of stay (3.3 v 4.5 days mean stay in hospital) and use of fewer lab and diagnostic tests compared with similar patients in hospital acute care,” the authors concluded in an analysis of the program for the calendar years 2009 and 2010.

Overall patient satisfaction was high in both settings, with mean scores of 90.7 and 83.9 respectively, as measured by a post discharge survey.

The telehealth unit allows instant communication with an offsite nurse24 hours a day, and provides basic tools of a blood pressure monitor, stethoscope, oximeter and glucometer that can be used under the nurses direction.

Bruce Leff, who spearheaded development of the “hospital at home” model at John Hopkins, said that they have learned some basic lessons from a variety of innovation collaborations in geriatric health. Among them are that all healthcare is local, and local conditions are of paramount importance in choosing the appropriate model. Technical assistance often is key to implementing a model.

This article was published in the June edition of the British Medical Journal (BMJ 2012;344:e3997).For a full copy please email anz@baxter.com

Earlier this year Dr Tony O'Connell presented the keynote address at the 2011 QLD HITH meeting. Dr O'Connell's presentation outlines the role of HITH within Queensland Health, both presently, and moving forward into the future. While the presentation has a QLD focus, the issues are relevant to us all.

Watch the presentation here

A new study out of Boston reports favourable outcomes for patients receiving long term outpatient microbial therapy.

Click here for an overview of the study

One of the key attributes of HITH and home infusion of antibiotics is it's user friendliness for patients. This is especially important Cystic Fibrosis patients where home IV therapy becomes part of their lives.

Cystic Fibrosis is a genetic disease which affects over 3000 Australians. People living with this condition face challenges daily and must remain extra vigilant to stay well. Over the next few months the Home Calling will be sharing some inspirational stories with you of people who haven’t let Cystic Fibrosis slow them down. This week we meet Mary and the team at Westmead Hospital in Sydney.

I am 30 yrs old and was diagnosed with Cystic Fibrosis when I was just 1 month old. I live with my husband and two dogs and work full time in a busy marketing / event management role. Thankfully I only need to be admitted to the respiratory ward once or twice a year for an extended stay or a “tune up”. But managing my condition does require a lot of work – I’ve calculated that I spend around 20 hours each week looking after my health.

Cystic Fibrosis is a disease which is caused by a recessive gene abnormality. The main organ affected is my lungs – I practice daily physio and use a nebuliser to keep them clear. But I would say that really every organ in the body is affected by CF (except for the brain that is.)

My body can’t absorb fats properly, so I need to take supplements - sometimes up to 40 tablets a day - to help with digestion. It’s really difficult for me to put weight on, but very easy to lose it. So I really have to watch what I eat – not just how much, but also make sure I am not just loading up on soft drink and lollies. Most people with CF need to consume around one and a half times more calories than the average person just to keep up the energy levels! Long term use of medication can also affect the kidneys and liver, and I do have CF-related liver disease. Reproduction problems and reflux are an issue, and there is also an increased risk of diabetes and osteoporosis, although thankfully I haven’t had to worry about that so far.

Despite all of the challenges I think I’ve actually had a pretty good run. I work hard to look after my diet and exercise, and I really believe that being proactive in managing my treatment is my job. I’m always ready to challenge the status quo, and make sure I’m up to date with any new drugs or techniques that come along. Proactive patients tend to do better – I swim whenever I can as swimming is a great exercise to help maintain good lung strength. I‘m also a regular down at my local gym.

Whilst I do need the occasional hospital stay, on most occasions I can return home after a week or so and continue my IV antibiotic treatment using the Baxter Intermates. I am always on two different antibiotics. The first one is delivered over 30 minutes via the Intermate. The second antibiotic most people have in a 24hr Infusor, but I choose to use the Intermates for 3 x 2 hour doses each day. This means I can have my infusions when it suits, and then attend work and the gym as free as a bird.

I’ve been doing home IV since I was 12 yrs old. In the bad old days you basically had to have a whole ward set up in your home – bags, lines, and burettes - the whole lot. Gravity feed was a very hit and miss way of delivery drugs and required lots of guess work, plus the 100s of bits and pieces that went with it. I then progressed to pumps at home - this was better but I still had to reconstitute all of my own drugs which was a hassle.

With the Intermates you don’t need a pump, you don’t need to mix anything or work out flow rates. It’s all done for you. All you have to do is make sure your environment is clean and use proper technique to change the devices. When you are on home IV you are generally still quite unwell, so anything that takes all the fuss out of treatment is an absolute bonus. It’s so quick - I can have a shower without fussing and if I do need to pop out I can just pop it in my handbag.

At the end of the day, I do think that I have been pretty lucky – I lead a really full life and whilst there is a lot of extra work I do need to stay on top of things, I haven’t ever really known any other way. And if I do need some extra help I know that the team here at Westmead are ready to support me.

It's the age old question that HITH services have been debating since the dawn of HITH.

This question was hotly debated by an expert panel at last year's HITH conference - 2 doctors arguing against the motion that 'Doctors are necessary to run a successful HITH service', and 2 nurses arguing for the motion.

So, was the question settled once and for all?

You can watch all the action from this highly entertaining debate on the HITH Society Conference video website.

Finally the word is out. Newspaper headlines are screaming Switch to Home Care 'Could Save Millions' and Healthy Savings in Care at Home.

This wave of publicity about the economic benefits of HITH follows the release of an economic analysis of Hospital in the Home by the HITH Society of Australasia.

The research report, compiled by Deloitte Access Economics, found savings of up to 32 per cent to treat patients at home rather than in public hospital wards.

Talking to the Australian Associated Press, HITH Society President Gideon Caplan said, "The study shows there's a lot of money that can be saved by treating people at home and it also frees up beds so people needing beds can get into hospital, taking the pressure off emergency departments."

"People say in the future maybe hospitals will only be intensive care and operating theatres and other things can be treated at home."

"That may be 20, 30 or 40 years in the future but there's certainly more potential to treat people in this way."

This is certainly exciting news for all of us involved in HITH services.

For more information on the Deloitte Access Economics: Economic Analysis of Hospital in the Home, contact the HITH Society.

See some of the associated TV and press coverage here.

The latest video presentation to be released from last year's HITH conference is an excellent presentation from Dr Andrew Fuller titled "The Use of Antibiotics in the 'Hospital in the Home Program' - Antibiotic Stewardship".

Dr Fuller presents his experiences in treating infectious diseases in the HITH program at The Alfred Hospital using a number of interesting case studies.

Watch the presentation on the HITH Society Conference video website.

Earlier this year we hosted a HITH seminar and workshop in Brisbane focusing on issues in Queensland.

Attendees came from established and emerging HITH services, both in the private and public settings. The dynamic program was chaired by Prof. Gideon Caplan, and included insights from the HITH Society Australasia, Queensland Government, established Queensland HITH services and Hospital In The Home patients themselves. The seminar provided a forum for HITH workers to connect and discuss relevant issues and solutions to move HITH forward in Queensland.

There were some great presentations and delegate discussions which were captured on video. Although tailored to the Queensland market, many of the issues discussed are relevant to all of us. You can watch presentations from the day here at The Home Calling website.

There are so many benefits of HITH that we get excited about; the economics, the clinical outcomes, the professional opportunities; but at the end of the day the enhanced patient experience is one of the most rewarding.

Not all of us have direct contact with patients to see this first hand, so when this story was submitted to our website by a recent patient, we just had to share it with you:

My story begins with a fall. I am in my early fifties, fit and healthy and don't have any medical problems -I haven't even broken a bone before. But this time I wasn't so lucky. Falling down seven steps onto concrete resulted in a fractured ulna and shattered radius. A prosthetic radial head and a metal plate to secure the fracture of the ulna were installed by my surgeon. All was going well untill two weeks into recovery a staph infection developed at the surgical site (unlucky again). A surgical flush was followed by another stint in hospital on iv. I was not looking forward to the six weeks forecast to be on iv antibiotics to control the infection.

Thank goodness for the Baxter Infusor. I have been home for two weeks now and the infusor is working well. A community nurse calls each morning and changes the infusor daily and the surgical dressing as required, My local hospital also calls each day to ensure everything is OK. Apart from one minor blockage the infusor has worked brilliantly, infusing 8000mg of flucloxaccilin per day.

Having one's independence, being in the home environment and having the mobility that a regular iv prohibits has been fantastic. I have learnt a few ways to make life being attached to an iv easier. I have a hook on my mesh bag so I can hang the infusor wherever I am - shower head, bedside table etc. When I am out I carry my infusor in a satchel bag; hardly noticeable. Also, I have purchased some latex arm covers from the chemist that make showering much easier - I can put these on myself and have had no problems with them leaking and ending up with wet bandages - much better than plastic bags and tape.

I have been able to go shopping, to the movies, cafes and visit my friends and relatives. Life is not back to normal and I still have some healing to go, but it sure beats being in hospital for an extended period. I am sure being at home will contribute to a speedy and potentially full recovery.

Janean

Can you believe it's almost October already? Where has the year gone?

The good news is that this year's HITH Conference is just around the corner. Last year's HITH Conference was a fantastic success - catch some highlights here: http://hithconferencevideo.com/

This year's conference will be held in Darling Harbour, Sydney on November 17th and 18th 2011.

For more information, and to register for this unmissable event, visit the conference website at: http://www.hssevents.health.nsw.gov.au/hith/home

We hope to see you there for a fantastic couple of days!

Don't forget you can relive a lot of the action from last year's conference by accessing the videos here.

We are excited to be announcing the brand new Home Calling iPhone App!

This application allows you to conveniently access our latest stability shelf life data for a wide range of antibiotic agents compounded by Pharmacy Services in Baxter Infusor devices. It also provides access to all the latest Hospital in the Home news and resources from Baxter and The Home Calling.

Download the Home Calling iPhone App today.

Perhaps you enjoyed the HITH Society Conference last year, but can't quite read all the valuable notes you took? Would you like to review some of the sessions? Or perhaps you unfortunately couldn't make it to this inspiring event? (some of us had to stay at home to look after things at the hospital)

Today we are excited to be launching the conference video website featuring presentations from the 3rd annual HITH society of Australia Scientific Conference 2010 in full for your viewing convenience.

This online video library has been created for the HITH community by Baxter and The Home Calling in association with the HITH Society Australasia. Video coverage of presentations from the HITH conference are provided in full to help share the valuable ideas and experience that are contributing to the growing success of HITH in Australasia.

The site currently features about 12 sessions, with many more sessions to be added in the near future, so check back often.

You can access the site by logging into The Home Calling website (your username and password are available at the bottom of thehomecalling email updates or by registering on this site) and following the link in the HPC Resources section. We hope you enjoy this valuable resource with our compliments.

The sharing of ideas, knowledge and experience is the best way to continue expanding and improving HITH programs throughout Australasia.

Perhaps you have a colleague or associate, within your hospital or elsewhere, who could benefit from some of the combined wisdom from the HITH community.

Simply point them to the following URL, so they can also take advantage of this great resource: http://hithconferencevideo.com

Earlier this year The Home Calling team travelled to South Australia to bring you episode 2 of the Home Calling documentary series.

In episode 2 we visit the well established Hospital @ Home ward at Flinders Medical Centre to get some insights into their operation. While in Adelaide, we also go behind the scenes at Baxter's compounding pharmacy to find out more about their HITH services. Finally, and most inspiringly for all involved in HITH, we go behind the scenes at the home of one of Flinders Medical Centre's patients. It's always refreshing, especially for administrators and those with limited patient contact, to see first hand the incredible positive impact HITH services have on the lives of patients and their families.

View episode 2 here

On March 31 Baxter and The Home Calling sponsored a special HITH seminar in Brisbane. The Seminar was designed to bring together key practitioners in HITH to stimulate discussion on funding of at home services and how various services have successfully implemented programs or are looking to expand patient services.

During the event, lots of valuable ideas were workshopped, and information shared. The Home Calling team was there to capture the action and we look forward to sharing the outcomes of this event with you, and particularly with our QLD members in the very near future.

Watch Pauline Dobson's excellent presentation on John Hunter Hospital's trial of nurse loading of infusors to fill the gap between therapy prescription and delivery of a seven day supply of pre-filled infusors from Baxter Pharmacy Services. This presentation was given at the 3rd annual HITH Society of Australasia Scientific Conference in November 2010.

Launch Video (you will need to log in - refer to your Home Calling email newsletter for a password, or subscribe today for access).

A pdf of the presentation slides is also available here.

The new Christchurch Pharmacy Services and Distribution Centre was opened by Prime Minister, the Hon. John Key at a recent reception.

The NZ$3.6 million medication compounding facility will service all six South Island District Health Boards (DHBs) who signed a joint public/private agreement with Baxter in 2009 for the provision of aseptic compounded products including chemotherapy for cancer patients and antibiotics delivered via the Baxter Infusor.

David Akeroyd, Managing Director ANZ says: 'Baxter is proud to be involved in this landmark private/public partnership and continue our investment and expansion to support the NZ health infrastructure. The Baxter Pharmacy Service facility will ensure capacity for the growing demand of compounded medications and continued support of the six local DHB's with all Baxter products, as well as Renal home patients from one consolidated facility.'

Baxter elastomeric Infusors provide 24 hour continuous antibiotic infusion using a small, portable and simple elastomeric pump device. Many HITH wards find the device central to increasing ward efficiencies, as well as patient satisfaction.

The 24 hour infusion offers both hospital and patients requiring antibiotics the convenience of once-a-day visits to change the device. In some cases, changing the Baxter Infusor could also be done by a household family member.

Watch our demonstration video for an overview of the simple procedure for changing the Baxter Infusor.

We invest heavily in research and development to bring you the most convenient product and services. One of the areas we continually research is the stability and shelf life of compounded antibiotics in the Baxter Infusor.

We've created a handy feature on the website that allows you to choose a particular antibiotic, and instantly retrieve its stability and shelf life data.

Click here to access the shelf life data feature.

As many of you may be aware, the Victorian Department of Health conducted an extensive, externally conducted review of HITH programs across Victoria in 2009, with a final report just recently published.

The review confirms the many of the benefits of Hospital in the Home programs, and also outlines some recommendations for HITH going forward.

Click here for more information about the review and to access the final report.

We'd love to hear your HITH story and share it with the rest of the HITH community or feature it in one of our upcoming episodes of The Home Calling video series. So please, get in touch with your story or any feedback on The Home Calling.