Photo by Mark Duffel | Unsplash
Early during the COVID-19 pandemic, the emergency department (ED) team at a HealthPartners hospital in St. Paul, Minnesota, saw an 84-year-old man with a history of dementia, diabetes, and heart disease. He needed IV antibiotics for a foot infection, but his family knew from experience that he was likely to become delirious while in the hospital, especially since new COVID-related restrictions meant they were not allowed to visit. Based on these concerns, his family declined hospital admission.
After participating in the Home-based Acute Care Learning and Action Network convened by the Institute for Healthcare Improvement and the West Health Institute, HealthPartners had a viable alternative to offer this patient and his family: HealthPartners’ Hospital@Home program. After discussing potential risks, the patient was enrolled in the program, and for three days received IV antibiotics, checks of his labs, and daily hospitalist visits in the comfort of his own home surrounded by his family, the people best able to help him avoid delirium.
As the name implies, the HealthPartners Hospital@Home program provides some types of acute care in patients’ homes. The goals for the program are to safely shorten the length of hospital stays or to avoid unnecessary admissions or emergency room visits. Multiple studies have found that home-based acute care programs can safely treat patients at lower cost and with neutral-to-positive impact on patient satisfaction.
Providing hospital care at home is not new, but changes in reimbursement for services, lessons learned from the pandemic, and other factors appear to be contributing to its increased acceptance. It can be challenging, however, to ensure high-quality care and patient safety in home settings. During a recent webinar hosted by the Danish Society for Patient Safety, Tia Radant, MS, NRP, Director, Community Paramedicine; Chrisanne Timpe, MD, Medical Director, HealthPartners Hospital@Home program; and Danielle Hermes, MS, Senior Quality Improvement Consultant, HealthPartners, described the journey of their Hospital@Home program. They shared the following advice based on what they have learned over the years:
- Remember that technology isn’t everything. There are many devices on the market to monitor vital signs and transmit data, and Hospital@Home has piloted some of them. “We may do that again,” Radant remarked, “but right now, we've peeled the program back to its basics and are selecting patients for whom technology is not a necessary support in their recovery.”
- Find the right patients. The HealthPartners team reported that it took time to determine the patients most appropriate for their program. They cautioned against trying to serve too many patients with too broad a set of needs and highlighted the importance of patients and families agreeing that providing care at home is best for the patient. “Patients need to want to do this,” Radant noted. “Patients and caregivers need to be engaged in the plan.”
- View every case as a PDSA. As Radant remarked, “You will learn from every patient that you enroll.” Using the Model for Improvement and testing small changes will provide opportunities to learn what works and what adjustments may be needed.
- Collaborate across disciplines. Planning Hospital@Home began with a large group of stakeholders. While Radant, Timpe, and Hermes now form the core team, they have maintained strong partnerships across disciplines. According to Radant, “We need to have someone at pharmacy, at medical equipment, in our lab, our leaders, our finance team. Everyone has had to be engaged and ready to offer support as we’ve learned and grown the program.”
- Trust the people who work most closely with patients and families. In Minnesota, paramedics can seek advanced certification to be community paramedics (CPs). CPs work to increase access to primary and preventive care and decrease use of emergency departments. “Our community paramedics have worked on our 911 ambulance system, and they are passionate about [the home-based acute care] model being something that benefits patients,” said Radant.
“The feedback on the Hospital@Home program has been so positive,” said Timpe. “People just want to be home.”
Laura Baker, CPHQ, is an Institute for Healthcare Improvement Project Manager.
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The original webinar recording hosted by the Danish Society for Patient Safety.