A technique Israel might defend hospitals from overload throughout COVID spikes

As COVID-19 rises again across Israel, the country should encourage sick people who do not have the virus to use home health care to keep hospitals from collapsing, keep the country out of lockdown, and the economy keep open.

“We need a new paradigm in the way we deliver our care,” said Dr. Itamar Ofer, President and Chairman of the Sabar Health Home Hospital. “Secret health care is a must for Israel.”

Prime Minister Naftali Bennett has said he will shift the country’s COVID policy to one that focuses not on total coronavirus cases or severe patients, but on whether or not hospitals can handle their case numbers, according to a report by Dana Weiss from N12.

In accordance with this policy, the government will only put in place a short, effective and efficient lockdown when hospitals are on the verge of collapse.

The third round of Pfizer vaccines, which Israel began giving people over 60 last week, should reduce the number of serious cases the country is seeing. Coupled with efforts to promote home inpatient treatment, Israeli hospitals may never come to a breaking point.

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“Before the outbreak of the current pandemic, hospital occupancy in Israel was already the highest in the developed world, while the death rate from infectious diseases, which has doubled in the last two decades alone, was not only higher than any other developed country, it was 73 % higher than the second-place country, ”said Prof. Dan Ben-David, President and Founder of the Shoresh Institution for Socioeconomic Research and Faculty Member in the Department of Public Policy at Tel Aviv University.

During the previous three waves of coronavirus, Israel closed three times to ensure hospitals did not become so overloaded that patient care suffered and people died, such as 47-year-old Moshe Harazy father of five in January.

He was being treated for COVID-19 at Tel Aviv Sourasky Medical Center when the breathing tube on his ventilator loosened and staff were unable to reach him on time. A hospital statement said the team “faced multiple alarms at once in the intensive care unit” and that “staff were busy responding to other patients’ emergency alarms and took several minutes to evacuate”.

The hospitals were overcrowded with around 2,000 coronavirus patients during this period, including more than 1,000 in serious condition. Serious patients, especially those who are intubated, must be treated in intensive care units.

However, as Ofer told the Jerusalem Post, about 20% of the people cared for in any of the country’s 4,500 internal medicine hospital beds could be treated at home – that’s about 900 patients.

In fact, only an average of 100 of these patients use the country’s home health system, even though it is covered by health insurers and saves money.

“The most expensive way to treat people is in the hospital,” said Ofer, who is also co-chair of the World Hospital at Home Congress. “If there is an alternative, you have to try to use the alternative.”

Hospitals at home cost around a third less than hospital admissions, according to Ofer. And the indirect costs are even higher because they also save re-admissions to the hospital. Around 20% of all people discharged from the hospital will be readmitted within 30 days, he said. Home hospital stays cut that number in half to around 10% in Israel.

It also reduces the chances of older, immunocompromised people developing infections unrelated to the disease they are being treated for in the hospital, and gives them the convenience of being treated in a familiar setting.

Home hospital care means that a team of medical professionals takes clinical responsibility for the patient at home. They are available around the clock for emergencies. Otherwise there is one visit each day by a doctor, a nurse and a paramedic.

Chaim Freund, 50, from Jerusalem was recently admitted to a local hospital with cellulite. When he was released from the emergency room, his doctor gave him the choice between being transferred to the hospital’s internal medicine department or treatment by the Sabar Health Home Hospital. He decided to give Sabar a chance.

“I got a call from the doctor and he came to me the night I was discharged,” Freund told the Post. “He gave me antibiotics and a nurse came on Friday and then again in the afternoon and then in the evening.”

Every day a professional came to check his vital signs and do his blood work, he said, describing how the team brought a box of all the materials they needed to their home on the first day and every time a member of staff arrived he would or they use what was needed or fill in what was missing. The same doctor stayed with him until he recovered.

“It’s definitely more pleasant to be at home and I had the feeling that I received the same care as in the hospital,” said Freund. “This is the message people need to know: there is an alternative. A hospital is a place of germs and it’s not really a place to be. It was almost as if they had set up a mini-hospital in my home that was specially tailored to my needs. “

Investing in strengthening the home hospital system and promoting it with the right patients could make Israel successful in the future.

Israel is aging. Each year the country has roughly an additional 24,000 people over 75 and Israel is projected to end the decade with 70% more people in the age group over 75 than before. Older people tend to get sicker and need more medical care.

For this population group, “home nursing could be a determining factor,” said Ofer.

The COVID-19 crisis is not over yet. Israel needs to look for the right ingredients so that the public can live with the pandemic. Home hospitals should be part of this recipe.

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