PRIMARY: Doctors Taryn and Ben Gaunt are registered on Quro Medical’s Hospital-at-Home which will launch in Port Alfred next week. Port Alfred will be the first small town in South Africa to implement the service. Picture: SUE MACLENNAN
‘Hospital-at-home’ option set to launch
Families save travel and accommodation costs, medical aids and patients save on eye-watering hospital bills and people recover better. Those are some of the benefits that Hospital-at-Home, a groundbreaking system of health care implemented in South Africa by innovators Quro Medical, offers patients. While the model has been running for a while in bigger centres such as Gqeberha and East London, Port Alfred is the first small town in South Africa to offer the service.
Local doctor couple, Ben and Taryn Gaunt will be implementing it locally. Ben explains how it works:
“Adults who qualify for admission to a general ward or step down facility (eg early discharge) can be admitted to hospital in their own home,” Ben said. “Quro – the company that runs the programme – employs a professional nurse (sometimes a clinical associate) who visits the patient to on-board them, and gets them linked up to the remote monitoring as well as administer any treatment that is needed.”
After they’ve been fitted with an electronic monitoring device, the patient is monitored 24/7, via a central control room, with a doctor. The monitoring data is also available for the patient’s local “face-to-face” doctor to check on, via an app. The patient receives daily or twice-daily visits from the nurse, and the treating doctor checks in with them by phone.
“Obviously, if the local doctor needs to check up on the patient in person, they will do so.”
Any other input – further investigation and allied health visits for example – can also be arranged, with Quro handling the logistics. Often unaffordable for people on a hospital plan, billing for special diagnostic procedures, and sometimes even specialist appointments, is covered under the hospital admission.
“The doctor (and others) are reimbursed as per hospital admission rates, with most schemes offering an additional amount as incentive to use the service” Ben explained.
Emergencies are dealt with via control room and doctor (at night the control room can take full responsibility if that is the preference).
Quro has established direct close relationships with the EMS, pharmacies and diagnostic laboratories.
“It seems like a real win-win-win,” Ben said. “Patients get treated and monitored properly, all in their own home; doctors get to manage their patients properly – especially those who refuse a trip to hospital in Gqeberha or East London – and get properly reimbursed for it; and medical aids save about 30-40% compared to standard hospital admissions.”
Doctors sign up with Quro individually. When they have a patient they want to admit, they send a one-page referral, including prescribed medicine and other therapies, to Quro.
Quro manages the medical aid authorisation and other pre-admission aspects, before on-boarding the patient.
For the doctors Gaunt, Hospital-at-Home complements the ‘Healthy at Home’ emphasis of their practice. Reversing the trend for patient care to happen at doctors’ rooms, they promote the idea of home visits, especially to people who struggle with mobility, whether from acute or chronic illness.
Hospital-at-Home will launch in Port Alfred on April 1, 2025. The service will be available to GPs with patients in Port Alfred, Bathurst, Kenton-on-Sea and Kleinemonde. Makhanda is set to follow.
Health care practitioners who would like to sign up with Quro Medical for the Hospital-at-Home programme should contact the company directly. Their details are on their website, https://www.quromedical.co.za/
Game changer for patient care
The pros of a Hospital-at-Home admission will be obvious to anyone who lives in a small town or rural area and has had to leave their home base to be admitted to hospital miles away from family and friends. But so will the cons. Talk of the Town asked Ben and Taryn Gaunt about both.
How does Hospital-at-Home differ from frail care in a retirement facility, or the home-based care that an organisation like Palcare provides?
You could have terminal cancer, but you get pneumonia and that can be an admission, from which you are discharged once you recover. Elderly people in frail care are already in care, but they need extra care on top of that.
Frail care and assisted living facilities have got nursing sisters and other grades of nursing care there. They’re doing a bit of wound care here and there, pressure care to prevent bedsores, monitor blood pressure etc. but they’re not providing medical intervention.
A person might get a bad urinary tract infection or be dehydrated from severe gastro. You might only need to give the patient two or three litres of fluid over 24 hours and they’ll be much better again. As things stand, you have to send them all the way to [Gqeberha] for that. Hospital-at-Home would allow them to be registered and admitted, receive the treatment they need and have 24/7 monitoring.
This applies to any patient who lives at home or in a care facility; however, one of the current Hospital-at-Home admission criteria is that the patient must be 18 or over.
There are other stringent admission criteria for Hospital-at-Home. The patient’s condition should be one that would usually require admission to a general ward, not high care, ICU or surgical. We’re definitely not going to do angiography or small operations on your couch at home. We won’t do anything that we wouldn’t do in the rooms.
There’s quite a broad category of patients who need a three to five day admission and sometimes it’s really not the best thing for a patient to ship them off to Gqeberha.
In a hospital, a nurse comes around two or three times a day and takes your vitals and writes them on a piece of paper; whereas this piece of technology stuck to your right upper chest constantly monitors your ECG, respiratory rate, temperature, 24/7.
Is it safe?
The 24/7 monitoring means it’s an early warning system: if your temperature and pulse are going up, the team can intervene early.
One of the bigger medical schemes also uses it for post-discharge monitoring for 30 days. Any change in the monitored parameters triggers an in-person visit to check up on them. Sometimes it’s even before the patient realises something’s wrong. That medical aid’s readmission rate is substantially better. We think other medical aids will probably pick up on it as well.
What about emergencies?
In the case of H@H the nurse is employed by Quro and there are established partnerships with the ambulance service. Here in Port Alfred, Gardmed are on board: they will respond immediately if Quro phones them and directs them to a patient.
This doesn’t replace actual doctor-patient care though?
Not at all. Here is a typical scenario. Your grown-up children travel from overseas to visit you here in Port Alfred, where you live. Your go to your doctor with a bad strain of influenza, they tell you you need medical intervention, but you say, ‘no way am I going to hospital over Christmas!’.
But we know you need to be admitted. Under Hospital-at-Home, we write and send a one-page referral to Quro. You get your first dose of treatment – maybe it’s IV antibiotics – and then you go home.
Within two hours, the nurse will come to your home, set you up with all the monitoring equipment, make sure you have everything you need. Then they’ll come twice a day, depending on what medication you need.
Daily you’ll get a call from the Joburg control centre to see that everything’s all right, and a call from your GP. If the nurse is concerned, the GP will come and see you.
What kinds of costs are involved?
All of this is covered by the hospital plans of the bigger medical aids – most of which have partnered with Quro. That’s crucial because all the Plan Bs we’ve been making for people who don’t want to trek to hospital, that’s had to come from their out-of-hospital benefits.
The fact that your hospital plan pays for it means you can have blood tests, X-rays, daily visits or more frequently when needed, wound dressings, medication, CT scans (in Gqeberha, but covered by the hospital plan), dietician, physiotherapy – all the allied health services – covered under your plan.
From the point of view of the medical aid schemes, it costs them much less (15-30% less): shorter admissions, fewer hospital acquired infections (i.e. readmissions are less likely) and quicker recovery.
How will it affect or be affected by the NHI?
Budget constraints are likely to delay the implementation of NHI, but when it does come, anything that’s closer to the patient is going to be better for it. Hospital-at-Home really is an extension of the theory of primary care.
It saves money and heartache but what about medico-legal costs?
The evidence shows that a lot of medico-legal stuff is avoidable through good communication. Having said that, one obviously needs to provide responsible care. Patient selection is very important: the doctor who’s seeing the patient and admitting them must make a call, but Quro also has to okay it: that’s an extra check that you are within safe parameters.
The 24/7 monitoring is more than patients are getting anywhere, including private hospitals.
It’s important that the emergency setup needs to be in place. Here, Gardmed are on board. But if a patient presents with cardiac arrhythmia and they require immediate emergency care, there is also Port Alfred Hospital’s emergency room.
If you compare H@H with all the documentation and monitoring, with a patient who comes in to the rooms and has pneumonia but doesn’t want to go to hospital, the latter has way more risk for medico-legal than the formal, controlled setup that HH provides.
How did this paradigm shift happen? Is it one of the changes that the Covid pandemic brought about?
Quro’s co-founder and CEO Dr Vuyane Mhlomi started on a small scale in 2018. A first-class UCT Medicine graduate, he was a Rhodes Scholar and did his PhD at Oxford. His quest was ’What can we do to make health care better?’ He saw the gap. It’s not like it doesn’t happen elsewhere in the world, but a lot of the stuff that was on the fringes pre-Covid is suddenly a lot more understandable to the general public – that actually we can do whole lot more by making better use of the tech that we have.
That together with the imperative of cost-saving.
Do you think you’re going to get pushback?
There are some people who find tech intrusive or worrying and I’m sure there are people who won’t feel they are brave enough. But we’ve been talking about it since December and in mentioning it to patients and people out there in the community, I can’t name a single person who’s even been on the fence. Everybody’s like, ‘That’s amazing – that’s what we need!’. In Port Alfred especially. The only pushback likely would be from anyone maybe planning to open a hospital here. It’s one of those things that for some patients will be a game changer.
This is open to everybody – it’s not like we’ve got a franchise on it or something. It’s something every GP in town could offer.
Will you be able to extend it a bit – to Makhanda etc?
We’re the first small town in South Africa that Quro are bringing on board. They are already in all the big centres.
Their nurses obviously travel around, but they have an 80km radius. It means they can reach us and Makhanda from one base. We think this Port Alfred/ Bathurst/ Makhanda nexus is perfectly positioned for that. So it will expand to Makhanda in time; it’s a matter of getting it set up.
It’s all about the doctor who you see. If you see a doctor and they want to send you to Gqeberha and you don’t know about this, then you’re heading to Gqeberha. Whereas if you come and see a Quro-affiliated doctor and you meet the criteria for admission to hospital at home, you’re going to get admitted at home.
We see a lot of patients who fall into that category already; but the more the town comes on board and has that as an expectation, the more sustainable it is for Quro. They’re providing the people, bringing the tech and that costs money, so they need to have a certain number of patients for it to be viable. As soon as we’re hitting that, I think we’re going to see it expanding to Makhanda. And then it’s about the doctors there: there will be early adopters and late adopters.
This article was first published in Talk of the Town, March 27, 2025. The newspaper serving the communities of Ndlambe and the Sunshine Coast, with a weekly wrap of Makhanda news, is available at stores from early on Thursdays.
