colleen collogan, calvary mater hospital in the home: calvary mater hith program 10 years on
DESCRIPTION
Colleen Collogan, Registered Nurse, Calvary Mater Hospital in the Home delivered this presentation at the 2013 Hospital in the Home conference. This 2-day event is a nurse oriented program to improve HITH services and maximise hospital efficiency. For more information about the annual event, please visit the conference website: http://www.communitycareconferences.com.au/hospitalinthehomeTRANSCRIPT
Hospital in The Home 10 Years On
Calvary Mater Newcastle
Colleen Collogan – Registered Nurse HiTH
Wendy Johnson – NUM Haematology Unit
Calvary Mater Newcastle is a regional tertiary referral centre geographically
located in Newcastle NSW in the suburb of Waratah within the HNE Local
Health District.
Specialty Services provided at this centre include:
General Medicine including subspecialties in respiratory medicine, stroke,
geriatric medicine with acute aged care services
Cancer Services including medical, radiation oncology and haematology
Cardiac, Emergency, Toxicology and Pharmacology, Alcohol and Drug,
Melanoma Unit, Liaison Psychiatry
Surgery
Medical Centre – ambulatory care for all specialties
Outreach Services - Palliative Care, Hospital in The Home
Support Services
Co-located services (managed by HNE) include Mental Health & Breast
Screen
Introduction
Catchment Area
Service is provided within a one hour driving distance from the hospital
A Research Paper was prepared by CMN Haematologists' and
Haematology Nurses to investigate the idea of HITH intervention for
management of Post autologous Haematologous Stem Cell
Transplant (Post AutoHSCT ) for patients with multiple myeloma and
lymphoma. This research was published in the Australian Journal of
Advanced Nursing in 2006 by Johnson et al.
Data Collection Period: March 2001 to June 2003 = 28 months
33 patients underwent AutoHSCT for lymphoma or multiple myeloma at the Hunter
Haematology Unit.
13 were treated under the HiTH program (as they complied with the criteria)
Ratio 10 males to 3 females (10:3)
Average age was 48
The chemotherapy types were also taken into consideration. 9 receiving LACE
(Fludarabine, Cytarabine, Dexamethasone) and 4 receiving Melphalan only
treatments.
11 of the patients were readmitted to the Calvary Mater with an infection within 7
days of discharge from haematology ward.
Previous Project & Findings
Current Project & Findings
Metric 2003 Results 2012 Results
Data Collection Period March 2001- June 2003=28mths
September 2010 - December 2012=28mths
Number of Patients who underwent AutoHSCT for lymphoma or multiple myeloma
33 54
Number of Patients Suitable for HiTH 13 (9 LACE/4 Melphalan)
17 (7 LACE/10 Melphalan)
Gender Ratio 10M:3F 14M:3F
Mean Age 48 years 59 years
Readmissions 11 (84.6%) 13 (64.7%)
Total Number of Haematology patients seen by HiTH
98 119
Readmission Rates
Since 2001, there has been a 19.9% reduction in re-admission to hospital from the HiTH service within 7 days, for those receiving autologous haematologous stem cell transplantation (AutoHSCT) following LACE or Melphalan treatment.
19.9%
n=13 n=17
(Note: The lower proportion of readmissions could just be sampling variability, but it is promising
nevertheless).D
A survey was mailed out to 60 Haematology patients, asking about their
experiences with the HiTH service and sharing care management with the
Haematology Day Ward. Respondents were asked what the main benefits of
the service for them. Responses included:
Able to relax at home and spend time with family and sleep in my own bed.
My freedom and being home, plus the comfort of having knowing that nurses were
coming to me.
Support of family & friends, this helped my recovery.
Care and attention given to me outside the hosp helped me prepare for returning
home away from the cancer team.
‘Stay in my own home, benefits physically and physiologically. More pleasant to be
home with my family during this mentally anxious period and the shock of prognosis
as well as the trauma of treatment.’
Patient Survey Results
Start typing
Haematology Patient Survey Results
n=22 Response Rate: 37%
Case Study: Background
Acute myeloid leukaemia (AML) is a type of cancer that affects the blood and bone
marrow. AML is characterised by an overproduction of immature white blood cells,
called myeloblasts or leukaemic blasts. These cells crowd the bone marrow,
preventing it from making normal blood cells.
Case Study: Diagnosis and Initial Treatment
September 2009
• Joe a 53yo male.
• He presented to his GP with abnormal bruising.
• Haematologist at the Calvary Mater Newcastle diagnosis AML
• Joe consented to M12 clinical trial for AML.
• He had a full dose of chemotherapy induction (Big ICE (Idarubicin +
high dose Cytosine arabinoside + Etoposide).
• Joe was taken off the M12 trial.
Hospital stay 26 days Day Ward + HiTH = 41days HiTH visits =19
Bone marrow biopsy done November 2009 showed Joe was not
relapsing.
Remission
September 2010
Relapse of AML
Blood count dropped and confirmed with a BMB showing
10% abnormal cells.
Treated with FLAG (Fludaralaine, Cytarobine, Dexamethasone,
Granisetran) chemotherapy to re-induce him into a remission state.
Hospital stay = 7days
Day Ward and HiTH service = 25 days
HiTH visits =11
Joe continued to have blood products, injections, autoimmune drugs
and prophylactic antibiotics as an outpatient.
November 2010
Day Ward 8 days of FLAG chemotherapy and blood product
transfusions.
Hospital stay = 0
Day Ward & HiTH = 8 days
HiTH visit 1 only
Patient contacts with health services:
Inpatient at CMN = 28days total
Day Procedures = 6
Emergency Department = 5hrs
Out patient shared care Ward 5D = 76 visit.
HiTH = 31visits
Pathology interventions in excess of 424
Medical Imaging in excess of 26
Case Study: Bone Marrow Transplant
January 2012
After visiting a specialist
at the Westmead
Hospital he is scheduled
in for a bone marrow
transplant with an
unrelated mismatched
donor.
Late in January Joe
receives a bone marrow
transplant at the
Westmead hospital.
March 2011
The blood count is improving.
Bone marrow biopsy demonstrates disease in remission.
No longer on immune suppression drugs.
Joe returns to work and says “that he now enjoys a gifted life with
his beloved wife”.
January 2012 to present
Persistently elevated Iron level up to 1642. (Normal = 60-170).
Osteopenia (identified on bone mineral density).
No evidence of graph vs. host.
Remains oral antibiotics and calcium replacements.
Continue regular venesections.
Acknowledgements:
• Wendy Johnson – NUM Haematology Unit
• The HiTH Team – Margaret, Stacey, Anne.
• Lynne O’Brian – Assistant Director Clinical
Services
• Mandy Bassos – Administrative Assistant
• My children!
THANKYOU