As healthcare organizations consider how and where they deliver care to patients, many consider the hospital-at-home innovative care model as a promising approach to improve value. The program provides hospital-level care at home as a substitute for acute hospital care.
Older adults are the primary beneficiaries of this innovative care model since they are vulnerable to hospital-acquired infections and other complications of in-patient care.
The hospital-at-home program has proved effective in reducing complications while cutting the cost of care. Healthcare organizations seeking to adopt hospital-at-home programs are often required to develop new systems and roles while overcoming the resistance to change.
Before implementing hospital-at-home programs, an institution ensures that all conditions are right and the resources needed are available.
The following questions will help determine if your institution is ready for a hospital-at-home program.
- Is a lack of hospital capacity causing problems in your health system?
- Does your health system have the ability to offer care at home?
- Can your institution align the hospital, providers, and payment to develop a hospital-at-home program?
- Do you have physicians or nurses willing to care for patients in the home environment?
The hospital-at-home program might be appropriate for your organization if you answered yes to one or more of the above questions. Below are the typical steps that Hospital at Home programs follow.
An emergency department physician identifies a patient requiring admission for one of the target illnesses. The patient needs to be sick enough for hospitalization but stable enough to receive care at home.
The healthcare professional uses validated criteria to distinguish patients who should be treated in hospital settings from those whose needs may be met at home.
For example, patients who require multiple visits from specialists or need intensive services should be treated in hospital settings. Patients with cellulitis, chronic obstructive pulmonary disease, congestive heart failure, and community-acquired pneumonia are a natural fit for the hospital-at-home programs.
After establishing a patient’s eligibility, they should consent to participate before taking home. If a patient agrees to receive care at home, they meet a greeter to discuss the program, arrange for transportation, and deliver any biometric and communication devices needed to oversee care.
Next, a physician evaluates a patient and is often transported home by ambulance.
The caring responsibility is assigned to a physician, and the patient receives extended nursing care before admission. After a patient is a home, a nurse will make daily visits according to clinical needs. There will always be a nurse to attend to the patient in any urgent or emergent situation.
The caregiver meets the patient virtually to explain the treatment protocol. Other clinical staff, including physical therapists, respiratory therapists, and other caregivers, visit the patient for treatment purposes.
They may need to conduct tests like X-rays, ultrasounds, and electrocardiograms or administer medications and fluids intravenously. The assigned healthcare professional monitor, a patient’s vital signs electronically.
In some models, the physician uses telemedicine equipment to communicate or capture any decline in a patient’s condition when clinicians are offsite.
A patient may need to make a brief visit to the acute hospital for diagnostic studies and therapeutics that can’t be provided at home. These include magnetic resonance imaging (MRI), computerized tomography (CT), or endoscopy.
Healthcare professionals use care pathways such as clinical outcome evaluations, illness-specific care, and specific discharge criteria.
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Treatment continues until the patient is well stabilized to return to everyday activities. When stable, the patient is handed to their primary care physician.
The physician maintains oversight of the patient for at least a month to ensure they are not suffering any adverse consequences. During this time, the physician provides updates to the patient’s primary care doctor.
The benefits of hospital-at-home are apparent, but this innovative model has limitations. For example, this approach requires providers that are comfortable offering care without face-to-face contact.
Continuous communication is also a requirement among team members who operate virtually. The lack of a physician’s presence at home may inhibit patient confidence; for instance, they may not be sure of their medication dosage.
Hospital at home is an effective care model that more providers may consider after auditing programs address the above concerns.