Treatment at Home Improves Patient and Staff Satisfaction
By Matt Phillion
Going to the hospital is often life-saving, but not without additional risks—one in 31 patients encounter a healthcare-related infection (HAI), while between 700,000 and a million patients fall each year. For some conditions, the best option may be treatment at home, and organizations like NYU Langone Health are now using a care-at-home platform from Current Health, a Best Buy Health company, to enable them to treat qualifying, consenting, low-acuity inpatients at home.
The results have shown an increase in patient safety as well as improved, more sustainable staff experiences during a time of staffing shortages and retention challenges across the industry. The platform also arrives at a time when the organization is experiencing increased demand for inpatient services, says Eve Dorfman, vice president of NYU Langone Health.
“We’re about 20 miles east of Manhattan, with a dense population and major capacity issues here, especially in med-surg. We continue to see increasing volume in our ED. We have a commitment to provide quality health services to our community. This is a real challenge with increased congestion in our ED,” she says. “We needed to create a solution as we knew we had limited options to expand, so in order to meet the needs of our patients, we decided to leverage this option and bring the right level of care to our patients in their homes.”
The program went live in September 2022, with a little over a year from the first discussions to implementation. “It was a very assertive plan, and I think it was well worth it. To date, we’ve had 190 admissions, and we’ve seen a wide range of patients with varying conditions,” says Dorfman. “Our safety record is better than you’d see in a brick-and-mortar hospital, outperforming those metrics, and the patient experience highly outperforms the patient experience with brick and mortar, too.”
Equally important, the program has helped revitalize staff who might have otherwise stepped away from healthcare.
“We’re in a staffing crisis in the healthcare industry,” says Dorfman. “We were told we’d never be able to staff this program during a nursing shortage, but we’ve had nurses who were looking for a change, who were burned out during COVID, and who would otherwise have left the industry, who found this to be a great alternative. We had a waiting list of nurses who wanted to be part of the program, and our engagement and satisfaction have been superb.”
NYU Langone was near ground zero for COVID-19 in the U.S., with the first COVID-19-positive patient on Long Island.
“We were hit really hard,” says Dorfman. “We had patients in every nook and cranny, patients being cared for in conference rooms, nurses working around the clock. We saw the toll it took on the staff.”
There was so much frustration among healthcare workers of all walks, and only so much they could take before something had to give, Dorfman says.
“We were hopeful that this would provide a different care delivery model that was different enough that nurses would say, ‘Hey, I need a change from what I’ve been doing, but I don’t want to leave the profession entirely—let me try this,’ ” she says. “And they did. It was a leap of faith on their part, a brand-new service line, and we recruited very carefully, looking for people who were passionate about their work but were also critical thinkers who could work relatively independently and had good, robust experience.”
The experience appears to be a success for both sides: There has been no turnover so far, and the program has added staff along the way.
More satisfying, individualized care
Patients who have gone through the program have rated it with staggeringly high satisfaction scores—hovering around 100%, says Dorfman. The reason in part is because it enables them to heal in familiar surroundings.
“They’re sleeping in their own beds, they use their own bathroom, there’s no defined visiting hours,” she says. “Their family and friends can come and go as they like. They can watch TV as they are being infused with IV antibiotics, on the couch with their dog. The patient experience is just amazing.”
It’s not that NYU Langone hasn’t had happy patients in the brick-and-mortar setting, Dorfman says, but among patients who’ve been able to receive treatment at home, some have said they never want to go back. “We have to explain that it’s not always feasible, but there are a lot of acute medical conditions we can treat at home,” she says.
At-home treatment also offers providers a window into the patient’s living environment, which can help identify problems and improve their overall care delivery.
“It’s an opportunity to provide better care for the patient,” says Dorfman. “Say a patient presents with shortness of breath. In the hospital room, we treat them and they go home, where their life continues. But if they are treated for shortness of breath in the home, we can see what their life will be like when they are discharged.”
This enables providers to identify factors they wouldn’t see otherwise, getting a real look at a patient’s home medications, diet, and environmental factors that could be contributing to the issue they presented with. “It helps us navigate and individualize their care so they’re more successful,” says Dorfman.
The right patients for the program
Patients are selected for the program in two ways: Either they present in the emergency department with the right circumstances to qualify, or they qualify for a transfer after already being admitted. Selected patients tend to have lower-acuity diagnoses: pneumonia, urinary tract infections, or cellulitis, for example. They also need to be within 12 miles of the hospital so providers can reach them quickly if a change in condition occurs.
Certain factors eliminate a patient as an option, such as if they’ve sustained a recent fall. Also, at this time, Current is not enrolling patients undergoing continuous cardiac monitoring. “We want to maximize the effectiveness of the program and minimize risk to the patient,” says Dorfman. On the financial end, too, not all payers are paying for this type of care yet, though Medicare has already seen the value in it.
But patients who qualify for the program enjoy a seamless transition, she says. They are educated about the program, and a nurse meets them at home to get set up, where they are provided with a tech package. The nurse ensures that the patient’s home supports the tech and that the patient is able to use it independently or with the help of someone in the home. They are then monitored 24/7, remotely, by a nurse at the hospital.
“The patient has immediate access to a nurse 24/7,” says Dorfman. “It can be audio or video, and if there is a need, a nurse is sent out to the home.” Patients have a minimum of two scheduled in-person visits at home by an RN, and daily assessments by the physician.
Dorfman says enrollees have done well. “We’ve seen great quality metrics,” she says. “No hospital-acquired infections, no pressure ulcers.”
At-home treatment also helps elderly patients with sundowning and the confusion of waking up in a strange place, which can often extend the length of stay for inpatients and involve medications that can have additional side effects.
“When you increase the length of stay, you increase the risk of medical errors, falls, HAIs, and so by addressing this side effect of hospitalization and bringing them to familiar surroundings, you’re minimizing those factors,” says Dorfman.
While staff engagement and patient satisfaction have been very high, Dorfman notes that change management for such a program can be an uphill battle.
“We’ve been taking care of patients in brick-and-mortar settings for 100 years. It’s how clinicians learn, it’s the model they’re used to, so trying to change the acute care model is sometimes like turning a cruise ship around. It can happen slowly,” says Dorfman. “We’re doing it, and we have early adopters who are champions who are really helping us turn the ship around.”
Clinicians had initial concerns about the technology because they wanted to make sure they were truly able to monitor the patient reliably, but they’ve had nothing but good experiences with the interface for the first nine months of use. “It’s much easier than we thought it would be, and the patients agree,” says Dorfman.
Looking to the future, Dorfman hopes this concept can be expanded. “Our mission is to take care of patients and provide them with the right level of care in the right location that’s best for them, and because this is occurring in the home, we’re able to individualize the care for the patient and really make a difference,” she says. “We’re really looking forward to where we go from here. The sky’s the limit.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.