Hospital at Home helps improve patient flow
December 1, 2012 4 minutes read
Hospital at Home helps improve patient flow
Patients receive services at home
Presbyterian Healthcare Services' Hospital at Home program, which provides acute care services in the homes of patients who might otherwise be hospitalized, has improved patient satisfaction and cut the cost of hospital care by about 30% for the Albuquerque, NM-based integrated healthcare delivery system. The average length of stay for patients in the program is 3.5 days compared to 5 days in the hospital for patients with the same diagnoses.
The program is based on a care model developed at Johns Hopkins Medical Center by Bruce Leff, MD, and focuses on patients with heart failure, chronic obstructive pulmonary disease, complicated urinary tract infections, community-acquired pneumonia, cellulitis, dehydration, nausea and vomiting, stable pulmonary embolism, and deep venous thrombosis, says Karen Thompson, OTR, CCM, director of hospice and the Hospital at Home program for Presbyterian Home Healthcare Services.
"The patients in this program are stable but still need medical care. This is not a substitute for home care. It's a substitute for hospital care," Thompson says.
To be eligible for the program, patients must be insured by Presbyterian Healthcare and live within 25 miles of one of the three hospitals in the Presbyterian system. They are referred by the staff on the hospital's acute care unit, the emergency department providers, their primary care physicians, urgent care centers, and home health care. They are assessed by physicians in the Hospital at Home program who screen the patients for medical conditions, as well as their functional capabilities, and their support system at home.
Patients in the program tend to recover faster than patients who remain in the hospital because they are in a familiar environment, says Melanie Van Amsterdam, MD, an internist and one of the physicians in the Hospital at Home program.
"They have a lower instance of hospital-acquired infections, fewer falls, and less delirium. Patient satisfaction is really high and the program helps with patient throughput," Van Amsterdam says.
The program is staffed by two full-time physicians and one full-time advanced clinical nurse specialist, who are on call 24 hours a day, seven days a week and who work with Presbyterian Home Healthcare's staff of nurses and home health aides to provide in-home care for the patients in the program. In addition, a patient care manager, who is a registered nurse, is the direct supervisor of nurses and home health aides and assists the physicians in assessing the patients to determine if they are appropriate for the program. When needed, the patient care manager also visits patients in their homes. The team also includes customer service representatives who verify coverage, arrange for post-hospital services, and get the patients' prescriptions filled before they leave the hospital.
When appropriate, the home care agency's physical therapist, occupational therapists, and speech therapists visit the patients, although most patients do not start rehabilitation while they are in the Hospital at Home program. Many of the patients transition to home care after they are discharged from Hospital at Home.
"Patients don't have to be totally independent to participate in the program, but they do need to be able to go to the bathroom and get their meals, or have a caregiver in the home. If we feel the patient is appropriate for the program and the emergency department provider or the hospitalist agrees, the patient care manager or physician describes the program to the patient and family and offers them the option of receiving healthcare services at home or remaining in the hospital," Thompson says.
Before the patient leaves the hospital, the team arranges for needed equipment and services, such as oxygen or infusion, and gets patients' prescriptions filled through the hospital pharmacy so they can go home with their medication. The hospital staff give patients their next dose of medication so they will have time to get home and get settled before having to take more medication.
After the patients get home, they are visited by a nurse within an hour. Then a physician visits once a day and nurses come to the home twice a day if it is clinically needed. Patients' vital signs and key clinical indicators are closely monitored. When the patients are getting close to being discharged from the program, the nurse may visit only once a day.
"The program is a win-win situation for everyone. Patients like the program because they can recuperate at home, instead of the hospital. The health plan can be sure that their members receive better care delivered at a lower cost, and it improves patient flow by freeing up beds for other patients, something that is very important in the respiratory infection season when the hospital is often at capacity," Van Amsterdam says.
Presbyterian Healthcare Services' Hospital at Home program, which provides acute care services in the homes of patients who might otherwise be hospitalized, has improved patient satisfaction and cut the cost of hospital care by about 30% for the Albuquerque, NM-based integrated healthcare delivery system.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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