Mobile Inpatient Care @ Home

MIC@Home is the delivery of acute hospital care for suitable groups of patients in the patient’s home as a substitute for hospital in-patient care. Mobile hospital care teams deliver selected inpatient-level services at home, including regular visits by doctors, nurses and therapists, intravenous therapy, and investigations.

MIC@Home provides acute hospital care in the patient’s home as a substitute for in-patient hospital care, whereas transitional care services (known sometimes as hospital-to-home, or H2H) provide post-discharge supportive care of recovered patients with the aim of providing medical care support to reduce re-admissions. Home medical services are provided by primary care providers and are not equipped to treat acute hospital care conditions. Home hospice services are specific services aimed at managing patients with terminal/life-limiting illness at home.

With a rapidly ageing population and higher chronic disease burden, there will be an increase in demand for healthcare resources, including acute hospital beds. Building more hospitals will not be a sustainable solution.

Furthermore, elderly patients are especially susceptible to hospital acquired complications which include infections, functional deconditioning, disorientation, etc. The development of alternative models of care such as MIC@Home will mitigate some of these risks.

Patients and their families do take up more active roles in caring for the patient during their MIC@Home admission. These may include assisting with ADLs (Activities of Daily Living) and measuring vital signs (temperature, blood pressure, and oxygen saturations)

A study conducted by NUHS , one of the pilot sites for MIC@Home, noted most of the caregivers and patients felt the programme provided comfort and convenience. Caregivers who opted for MIC@Home felt more involved in patient care and were motivated by a sense of duty to enable their loved ones to recover in a familiar environment at home.

There are other benefits as well. Programme nurses are able to provide more targeted caregiver training and education in the patient’s home environment and assess patient self-management and caregiver competency, which are all key factors to empower patients and their caregivers to manage their own care and health.

Patients should consult their doctors to determine their eligibility for MIC@Home. Generally, patients assessed as suitable are clinically stable, and while they require inpatient hospital care, their conditions are generally less severe. They will also need to be able to use tele-communications to communicate with the care team virtually. Patient would need to be able to communicate with the care team via virtual means such as through mobile phone or video-conferencing platforms. They can be safely cared for at home and manage their medications on their own or with the assistance of a caregiver.

Majority of the cases in MIC@Home are adult general medicine cases. The top few diagnoses include cellulitis, urinary tract infection, pneumonia, exertional rhabdomyolysis, dengue, uncontrolled hypertension, diabetic complications.

Examples of diagnosis under the specialty use cases include neonatal jaundice, paediatric eczema, pelvic inflammatory disease, terminal discharge cases (<1 week).

Home visits by a multidisciplinary care team, which includes doctors, advanced practice nurse (APN), staff nurses, pharmacists, therapists and medical social workers as appropriate.

Medication counselling and dispensing. Counselling can be done in-person in the hospital before the patient leaves for home or provided via tele-consult. Intravenous medications would be dispensed daily while oral medications would be dispensed once every 3-4 days. These would either be brought by the care team to the patient during their home visit or couriered to patient’s home if urgent.

Monitoring and capturing of adverse events or incidences (e.g. falls, new pressure injury, thrombophlebitis, delirium, drug allergy, medication error, CAUTI).

Common procedures such as intravenous hydration, intravenous antibiotics, ultrasound bladder scanning, ECG, wound dressing/ insertion of urinary catheter, venipuncture and intravenous cannulation.

Therapy services such as postural hypotension management, acute functional decline physiotherapy, occupational therapy for home assessment can be provided.

The care team is accessible 24/7. During office hours, calls from patients are picked up by the MIC@Home staff on duty, who would escalate to the doctor if necessary. After office hours, phone calls from patients are routed to on-call doctors, who would assess the situation and recommend/follow up with an appropriate action.

Patients and their caregivers are educated to monitor for signs and symptoms of medical emergencies and to call 995 immediately if these are observed.

To further mitigate risks of deterioration, all hospitals participating in MIC@Home will put in mitigation measures such as:

• Careful patient selection based on clinical assessment.

• Clinicians will be alerted when patient has abnormal vital signs.

• Informed consent stating that patients and caregivers have the option of being treated in the hospital and can be transferred back to the hospital at any time.

From April 2024, MIC@Home has become a mainstream model of care in our public healthcare institutions. All our hospitals intend to price MIC@Home similar to or lower than a normal hospital ward. Patients will be supported by subsidies, MediShield Life and MediSave, no different from a physical inpatient stay.