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