Hospital stays can yield to unintended consequences, especially in older patients. 20% of older patients will suffer delirium, one third will lose a functional status they will never regain, and 5-10% of older patients will contract a hospital acquired condition or fall while admitted to the hospital. To help mitigate these risks, Dr. David Levine, MD, MA is researching digital healthcare, care design, and the quality of delivered healthcare. He is leading Brigham and Women’s home hospital program to bring acute care into the home for patients who would normally be admitted for care.
Home hospitals provide community-based services usually associated with acute inpatient care. There are three typical models for home hospital care that have been promulgated.
- The first model is early transfer home, where patients are usually in the hospital for less than 24 hours.
- Next is substitutive care through the emergency department (ED). Essentially, patients present to the ED, but instead of being admitted, they get to go back to their home and have a home hospital unit deployed to them.
- The final model is substitutive care without the ED, where the patient stays at home with clinical support and never presents to the ED.
Levine, practicing general internist and research fellow in the division of general internal medicine and primary care at Brigham Health and Harvard Medical School, ran a pilot study at Brigham and Women’s hospital in Boston, Massachusetts to demonstrate that home hospital care could reduce hospital costs by 20% while maintaining safety and quality of care and improving the quality of life in the patient experience (his pilot is based on the substitutive care model where patients present to the ED, then return home for treatment and monitoring).
“We were able to treat patients with any infectious process that usually boiled down to cellulitis, pneumonia, and complicated UTI. We took patients with exacerbation of heart failure, and we took patients with exacerbations of COPD or asthma, as well,” Levine said.
The first challenge to overcome was creating a limited mobile lab so home clinicians could do blood work, ultrasounds, X-rays, and order echoes. “We were able to MedRec in the home, which is incredibly powerful and therefore we’re able to really organize patients’ chronic meds and keep them involved in taking them, and then supplement the acute meds.” The mobile lab also includes a tackle box filled with medication so new medication could be substituted or adjusted as necessary.
An additional challenge was HIPAA-secure communication with the patient and their clinical care team. Dr. Levine used HIPAAbridge by Everbridge for this pilot study. “We were able to communicate clinician to clinician, and with our patients in a HIPAA encrypted manner. Every patient received a tablet as part of the program. Patients could then send us text messages and photos in a secure manner if they were worried about anything at all through that platform, which worked quite nicely.” Encrypted video is also used through this platform, but most elderly patients we saw were more comfortable using the encrypted telephone feature.
Then, for monitoring, Dr. Levine used a monitoring patch on each patient. “We had continuous heart rate, respiratory rate, skin temperature, and continuous telemetry. We also had sleep detection, fall detection, posture, and step counts in near real time for patients.” This information is relatively new in home care studies, but is incredibly impactful to improving patient quality of care and life. Everbridge also monitored and reported the IoT devices used to monitor the patients during their home hospital care.
To learn more about Dr. Levine’s pilot study and hear real patient anecdotes, listen to our free on-demand webinar. We invite you to demo our clinical capabilities in our test site Everbridge General Hospital, where we can show you how the pilot study was conducted and other clinical applications available to medical teams. HIPAAbridge is part of the CareConverge clinical communications platform at Everbridge.