Regional reference centre for severe brain injuries
Home care service 3rd level
Model for the integrated management and care of chronic SV and SMC patients in the Calabria Region
The Oberon service plans and manages the home care of 54 patients with chronic disorders of consciousness (vegetative or minimally conscious state) through the integration of home visits by a remote team, automated remote monitoring of vital parameters, and teleconsultation from the operations centre of the S. Anna Institute, called UOS (Special Operations Unit).
The remote team, consisting of a specialist doctor, a professional nurse, a rehabilitation therapist and an OSS, makes scheduled visits with different frequencies depending on the patient’s clinical condition.
Remote monitoring is ensured through the home installation of sensor equipment connected via the web with the Special Operations Unit (UOS).
Vital parameters are detected through electro-medical devices and sent to the operations centre automatically, while the presence of medical and paramedical staff in the UOS is guaranteed during the 8 a.m.-8 p.m. time slot. The service also provides tele-consultation through video calls aimed at checking the patient’s general condition (skin redness, etc.) and supporting the patient’s family. It also provides technical assistance to ensure the constant functioning of the equipment installed at home.
It is an innovative service offered as part of integrated home care.
The S. Anna Institute guarantees:
the provision of technological devices, necessary for the telemonitoring of vital parameters, at the patients’ homes;
the home services of Doctors whose accesses will take place according to the defined treatment plan;
the home services of professional nurses, physiotherapists and OSS;
operation of the UOS (Special Operations Unit) guaranteed during the 8 a.m. – 8 p.m. time slot:
coordination of remote teams operational support via teleconsultation;
activities of medical and paramedical staff for telemonitoring;
activities of medical and paramedical staff for teleconsultation with the care giver and/or other family members;
activities of technical staff for the operation and maintenance of technological systems;
training and refresher training activities for nurses, rehabilitation therapists and home care assistants for care activities in the patient’s home;
training activities for care givers in the training room;
refresher training for general practitioners who expressly request it.