Avera’s Hospital@Home is reaching new milestones and earns high satisfaction among patients.
“What patients love most is getting the high quality hospital care they need for their condition, yet being able to sleep in their own bed at night and recover in the comfort of their own home,” said Bethlee Burke, CNP, nurse practitioner with Avera Hospital@Home.
Avera McKennan Hospital & University Health Center began piloting the program three years ago in collaboration with Avera@Home home health agency. Believing in the value of Hospital@Home, Avera leaders named it as an initiative in its three-year strategic plan under the pillar of Innovative Care Models Across the Continuum.
“With technology getting lighter and smaller, we’re seeing opportunities for getting away from all hospital care taking place within the brick-and-mortar walls of the hospital,” said Ronald Place, MD, Regional President and CEO of Avera McKennan. “I see it as the ‘usual care’ of the future – in which people can take advantage of their optimal environment at home yet still benefit from technologically advanced care.”
Typically, patients don’t arrive at the hospital expecting to return home to receive acute hospital care in their home environment. In fact, many patients don’t realize the program exists until they are asked if they would like to consider it. Yet physicians assess patients in the emergency department to see if they might be a good fit for the program, and patients can also be transitioned from a hospital unit bed to continue their hospital stay at home.
“We’re finding new means to take higher acuity patients,” said Magdalene Fiddler, MD, Avera hospitalist physician and Medical Director for Hospital@Home, for example, being able to offer IV antibiotics with the assistance of Avera Home Infusion.
Over 1,000 Patient Bed Days Saved
To date, Hospital@Home has saved 1,193 patient bed days at Avera McKennan, serving 570 patients.
“Patients receive the same hospital services per their care plan and the same high level of care at home that they’d receive in the hospital,” said Cynthia Kannenberg, Nurse Manager for Hospital@Home. Any needed equipment is set up at the home. Hospital meals are delivered to the home, ready to be microwaved. A nurse practitioner and nurse visit the home each day in person to assess the patient’s condition and deliver any needed treatments, as well as other caregivers as needed, including physical or occupational therapists.
Each patient receives a virtual rounding visit each day from an Avera hospitalist. If they have any needs or concerns, they can quickly contact their care team via tablet, 24/7. At-home patients have access to hospital resources including case managers, social workers and chaplains. They also have access to a wide range of specialty consults via telemedicine.
“When we round, it’s just like rounding at the hospital. It’s true telemedicine,” Fiddler said. “We can ask the same questions. We can look at a wound. We can observe whether the patient appears to be in pain.” Hospitalists can advise on any findings reported by the nurse practitioner who visits the patient in person.
Hospital@Home is for adults at least 18 years of age. Whether or not a patient can get hospital care at home depends on their condition, whether or not their care plan can be delivered safely in the home, and if they live within 30 minutes of the hospital. Examples of common diagnoses include pneumonia, COPD, heart failure, cellulitis and urinary tract infection.
Why Patients Often Do Better at Home
“Often, patients do better than they would in the hospital. They sleep better and rest more, they can wear their own clothes and move around their house as they want, possibly getting more exercise, which is often important in their recovery,” Kannenberg said. There’s also less fall risk and less risk of hospital-acquired infection.
Discharge plans are easier, because the patient is already home, living in the environment they’ll be discharged to.
Just as in the hospital, preventing readmission through a good discharge transition is a key goal of insurers because it saves costs. But it also saves the patient – money, discomfort of future illness and the life interruption of being hospitalized.
Hospital@Home was an innovation that grew out of the COVID pandemic. In November 2020, the Centers for Medicare & Medicaid Services launched its Hospital Without Walls initiative to address concerns about hospital bed capacity. Through a waiver-granting process, the initiative allows CMS-approved hospitals like Avera McKennan to provide inpatient-level care in the home environment for Medicare and Medicaid beneficiaries. It’s also an option for people insured through non-government insurance companies or private-pay patients.
