Technology, time pressures, insurance costs and other factors are driving rapid changes in the healthcare industry, forcing hospitals to find new ways to deliver quality care outside the walls of their brick-and-mortar institutions.
“The way we deliver healthcare today is not the way we’re going to deliver healthcare tomorrow,” said Dr. Richard Rothman, director of Integrated Hospital Care Institute at Cleveland Clinic Florida. “There’s a recognition that we have an opportunity to improve the delivery of care for patients, for the individual delivering the care, and for the organization.
“So how do we ensure that we create sustainable care delivery model? We take those three buckets and create the foundation for what we call hospital care at home. We know that across the country, healthcare systems every day are challenged. They are challenged with improving patient safety and improving patient outcomes. Our ability to do something better for patients, the people delivering the care and the organization at the same time is better than it’s ever been. Here to date we have admitted close to 450 acute inpatients hospitalized in their home in Vero Beach.”
Dr. Rothman said no other unit in Cleveland Clinic had patient experience scores as high as hospital care at home. Updated scores showed a rating of 98 on a scale where 100 was the best. Additionally, readmission rates for hospital care at home are significantly less than those in the main hospital and the number of healthcare-acquired infections that are common in hospitals are nearly nonexistent in hospital at home care.
“The patients do better,” Dr. Rothman continued. “I recently had a patient that was hospitalized in the brick-and-mortar hospital for a day or two and was subsequently transferred to the home. He was very ill. In the hospital, the patient was lying supine. Once home he was sitting on the couch with his dog next to him beside his IV pole. I’m not sure that same patient would have left the hospital [alive], if he had remained there. Today he is doing well.”
Hospital care at home is for acute hospitalized inpatients. These patients have the same level of complexity that is seen in a brick-and-mortar hospital. The program is designed to improve the experience for the patient while also addressing staffing shortages and the cost of care.
“The nursing teams have really started to transform how they deliver care,” Dr. Rothman continued. “They’re able to think about their interface with the patient, as opposed to being on the hospital ward running back and forth, in and out of rooms. The nurses are sitting at their station, responding to patients in real time, and communicating with families who help with the care. It’s a more personalized way to deliver care because the patients and their families are now actively participating. They are asking questions about the medications and care instead of just doing what the nurse said to do in the hospital setting.”
Taking the right doses of medication often is confusing for the elderly or those patients who have difficulty reading. Having a virtual nurse instruct the patient on exactly which pills to take and at what time can be done daily if there is no family member to assist. In doing so, this avoids taking pills more than once or not at all.
The nurses are stationed in the virtual command center located in Vero Beach. It’s called the CIVIC, which stands for Clinically Integrated Virtual Care Center. There are nurses sitting in the CIVIC that live and are employed on the Treasure Coast caring for patients outside our county as the hospital-at-home program expands into St. Lucie and Martin counties.
So how does one qualify for hospital care at home?
“You must first meet the qualification for an inpatient admission, meaning that when you are evaluated at the emergency department you require inpatient admission,” Dr. Rothman explained. “We’ve aggregated data within our EMR that allows us to immediately see if you live within a 30-mile radius and therefore qualify for potentially being admitted into hospital care at home. The physician goes through the clinical stability tool to determine whether or not you’re clinically eligible to be admitted into the home, meaning you don’t require an acute procedure or require an ICU or step-down level of care.
“Once it’s determined you qualify for at-home care and you agree that you would like to be treated at home, you will converse with a nurse via a tablet who will ask you a series of questions to determine if your home is suitable for at home care. Do you have air conditioning? Do you have running water? Do you feel safe at home?
“When you and your home have been evaluated, we take you home. Our nurse will ask about your favorite chair and room and set you up where you will be most comfortable. You’ll learn how to how to use the tablet that tethers you to a nurse. You can connect through your Internet, your land line or mobile phone 24 hours a day, seven days a week.”
It only takes an average of 27 seconds for your nurse and/or clinician to respond when you hit the button. You can also patch in a family member if desired. Your nurse will have your scheduled times for in-person visits and wellness checks. Your doctor rounds are also virtual.
“If the patient doesn’t respond to the scheduled virtual visit time, a health professional like an EMT will come to your home to make sure you are OK. While CIVIC has a team of dedicated physicians in their clinically integrated virtual care center, they are also able to link in virtual visits by your cardiologist, pulmonologists and other specialists.”
Hospital care at home has been available since April in Indian River County and will soon be available in St. Lucie County. The average length of stay for hospital care at home is about 5 days versus about 4.25 days in the brick-and-mortar hospital.
Patients have more time to get better because they don’t have to be released to make room for another patient. They aren’t being transferred to a skilled nursing facility to further recuperate either. Their recovery is actually quicker because they aren’t lying in bed. They are moving around, and they have their pets and family to support them.
Cleveland Clinic Indian River Hospital has been the pilot for the Hospital Care at Home program and it has been so successful that it’s being evaluated for implementation in other hospitals within the Cleveland Clinic organization. This model has been shown to reduce costs, improve outcomes and enhance the patient experience according to the American Hospital Association.
“The Hospital Care at Home program marks a significant departure from the conventional hospital care model,” Dr. Rothman concluded. “Patients hospitalized at home benefit from virtual consultations, real-time monitoring, and rapid responses to medical concerns, thanks to the on-the-ground support provided by our community of healthcare providers. Hospital Care at Home enhances the patient experience and improves patient outcomes.”
Richard Rothman, MD, is a hospitalist and the Regional Chair of the Hospital Medicine Institute at Cleveland Clinic Florida. He is based in Cleveland Clinic Indian River Hospital, where he leads the Cleveland Clinic Hospital Care at Home program. For more information about the program, call 772-567-4311, ext. 2000.
