Hospital@Home at UH Hits 500-Patient Milestone
March 26, 2023
UH Clinical Update | March 2023
Begun in response to hospital capacity demands at the height of COVID, UH’s Hospital@Home program is redefining itself. Having now provided care to 500 patients, it’s fast becoming a trusted and often even preferred way for patients with a variety of indications to complete their hospitalization and recovery experience successfully. With 24/7 monitoring by registered nurses using Remote Patient Monitoring (RPM), medical providers can assess a patient’s vitals, monitor interventions and medical stability, which previously required a patient to stay in the hospital.
The program still treats a good number of COVID patients, says Jillian Lavender, MSN, RN, ONC, Nurse Manager for Hospital@Home. However, over time, the program has expanded as an option for nearly all UH med-surg patients.
Common diagnoses include congestive heart failure, COPD, cellulitis, pneumonia and urinary tract infection. The program also consults with a UH cardiologist and nephrologist and welcomes other subspecialists who are willing to take part in the care of the Hospital@Home patients. The program is currently caring for patients who have undergone transcatheter aortic valve replacement (TAVR), and plans are in the works to expand the program to patients recovering from other cardiothoracic surgery, including coronary artery bypass graft (CABG) surgery.
Room for Growth
Typical census in the two-year-old program is still relatively low, Lavender says. But, she says, the program has staffing capacity for more.
“The Hospital@Home team includes remote nurses, paramedics who visit the patient in the home and professionals from Home Care, such as a physical therapist, occupational therapist or a specially trained paramedic or nurse to give an infusion,” she says. “When considering all those parties, we can triple or quadruple our capacity.”
Important Hospital@Home Metrics
Lavender says the Hospital@Home team is pleased with the results they’ve demonstrated so far for their patients. These include:
- Length of stay: 3.28 days
- 30-day readmissions: 7.26 percent
- Transfers: 6.84 percent
- Deaths: 0
Length of stay is about a half-day shorter than the national average for similar programs, Lavender says. And readmissions are well below what’s considered an acceptable level.
How to Refer to Hospital@Home
The first step in using Hospital@Home is identifying which patients are good candidates. Criteria include:
Basic Patient Criteria:
- Evaluated by ED or inpatient provider that identifies patient as candidate
- Patient is 17 or older
- Patient agrees to wear monitoring device
- When home, patient is willing to have pets restrained if applicable
- Able to support daily living tasks (such as bathroom and diet plans) or has a caregiver who can assist at all times
Patient Social Criteria:
- Permanent place of residence that is not an on-site medical care facility
- Heat in October – April
- Air conditioning when temperature is at least 80° F (27° C)
- Not receiving daily drug addiction medication (methadone)
- Not in police custody
- No history of domestic violence
If your patient is an appropriate candidate, enter the following order in the EMR: Transfer
Interfacility. Select Level of Care, Hospital@Home. This will trigger a communication to the UH Remote RN, who will contact the Hospital@Home team. That team will notify you via Halo conference call line for acceptance or declination rationale. If the patient is being admitted to Hospital@Home, the Remote RN will take care of arranging transport, meals and equipment.
Overcoming Misconceptions
If anything is hampering the success of Hospital@Home at UH, it’s perhaps its relatively low profile, says Anthony Muni, MD, Medical Director for the program and Chief Medical Officer for Utliization Management in the UH Accountable Care Organization. But, he says, UH caregivers should learn more about the good work the program is doing.
“A barrier has been the lack of general awareness about the program from hospital staff and understanding Hospital@Home’s capabilities,” he says. “For patients and their families, there is often hesitation about joining the program because they do not understand that much of the care in the brick and mortar hospital can be accomplished safely in the home. However, patients have been extremely happy that they have the opportunity to be cared for in the comfort of their home. We provide truly multidisciplinary care with a team of nurses, physicians/APPSs, medics, pharmacists, home care and care transitions who communicate multiple times per day. The program was originally built for COVID capacity management, but Hospital@Home can care for many of the patients who are currently in the hospital.”
Clear Advantages in Care
Nurse practitioner Ashley Summers, DNP, APRN-CNP, AGPCNP-C, FNP-C, AGACNP-BC, CCRN, has worked with several Hospital@Home patients over the past two years. She says she considers it a great example of what healthcare can be, creating a better overall experience for the patient. For example, she says, instead of a dozen or more different healthcare professionals each visiting the patient’s room to complete an individual task, rounds are bundled for convenience with Hospital@Home.
“At Hospital@Home, we simultaneously perform rounds with the patient, patient family, provider, pharmacist, pharmacy tech, nurse, medic, home care, social work, etc.,” she says. “At this time, the patient can have labs drawn, have an EKG, and receive meds and fluids. They can shower and sleep through the night. We can either deliver meals or help the patient eat a home-cooked meal. I see this service being the future of healthcare. As technology improves and the world moves to virtual, there are fewer reasons a patient has to stay in a hospital for IV Lasix or high-flow oxygen for the next several days or to wait for a consultation. I feel these patients can heal faster and more efficiently in their homes.”