Hospital at home

MARY REICHARD, HOST: Today is Thursday, May 11th. Thank you for turning to WORLD Radio to help start your day. Good morning. I’m Mary Reichard.

MYRNA BROWN, HOST: And I’m Myrna Brown. Coming next on The World and Everything in It: bringing back the doctor’s house call.

According to the CDC, more than 600-thousand hospital patients will contract an infection this year —just from being in the hospital. That’s about one out of every 31 patients.

REICHARD: But a growing number of hospital patients may not have to take that risk. Because they won’t actually be in a hospital. Instead, they’ll be treated through a program called “hospital-at-home” which might sound like a contradiction. But in a few big cities across the country, these new programs are bringing back a very old way of practicing medicine. WORLD Special Correspondent Maria Baer reports on one such program in Ohio.

MARIA BAER, REPORTER: Mary Ann Smiley is sick, but you wouldn’t know it to look at her.

MARY ANN SMILEY: I have a diagnosis of heart failure and lung disease.

The 76-year-old lives alone in a cozy suburban apartment outside of Columbus, Ohio. She’s trim and stylish in a bright sweater and blue jeans. And her living room is immaculate. There’s not a speck of dust on the shelves or a single smudge on the glass backdoor that overlooks a small pond. This was Smiley’s view two months ago, while she was technically in the “hospital.”

SMILEY: I had gone to an Ohio State walk-in clinic, and my oxygen level was in the 70s, so they sent me to the hospital.

And then they came to me and said we’re enrolling you in this hospital at home program, do you want to do that and I said of course! And they said ok, transport’s going to come at 1 o clock, and we’ll transport you to your home.

Smiley is one of the first 20 or so patients that the Ohio State University hospital has enrolled in its brand new “hospital-at-home” program. Similar programs have launched in Worcester, Massachusetts, in Seattle, Fort Wayne, and elsewhere. The idea is in the name: patients with certain conditions who would normally be admitted to the hospital are instead sent home. They’re guaranteed two in-person visits a day by a nurse and 24/7 electronic access to their care team.

SMILEY: Every morning I would take my blood pressure, oxygen level, temperature, weight, heart rate.

On Smiley’s first day in the program, a doctor and two nurses met her at home. She giggles remembering the way her doctor sat right down on her plush ottoman and pulled up her marble coffee table for a desk. He and his team gave Smiley a vitals monitor and taught her how to use it. They told her they’d come to see her twice a day, and someone else would deliver her medications.

SMILEY: I remember asking them if I could feed my birds, and they said of course you can feed the birds out on the patio.

Not all patients qualify for the hospital-at-home program. Those who are in the ICU or people who need major tests like MRIs or CAT scans can’t go home. But technological innovations like mobile x-ray and ultrasound machines are pushing the boundaries of what’s possible.

Rachit Thariani is the Chief Administrative Officer for OSU’s hospital-at-home program. He said it’s not just popular with patients. It’s also solving the hospital’s space and staffing shortages.

RACHIT THARIANI: So this program also then helps us free up capacity by caring for patients in the home and freeing up a hospital bed for somebody who really needs to be in a hospital bed.

Historians credit St. Basil—a Catholic monk—with building the world’s first hospital sometime around 370 AD. Basil challenged the ancient world to change the way it treated the dying, citing Jesus’ teachings to care for and love the sick and needy.

Our knowledge of science and technology has changed a lot since then. But our modern healthcare system is built on the largely Christian idea that sick people shouldn’t be abandoned. Some healthcare workers say treating patients at home brings back a personal touch that’s often lacking in the sterile corridors of a noisy hospital. Here’s registered nurse Megan Faga.

MEGAN FAGA: We perform care in their home with them, not to them. So often in the hospital me as a provider would order a CatScan, and the patient would get wheeled down to CATScan and they wouldn’t have a clue what was happening.

Faga works for DispatchHealth, a Denver-based company that staffs hospital-at-home programs around the country. Before this job, she spent 10 years as a hospital nurse. She says she spends more time with her patients now than ever before.

But being in patients’ homes also means she’s sometimes called on to do some non-traditional nursing work.

FAGA: I have created incredibly complex care plans for people with heart failure, and I’ve also cleaned up cat poop off of somebody’s living room floor because that’s what they needed in that moment.

According to Faga, the initial data suggests about a 20 percent reduction in mortality for patients who are treated at home instead of the hospital. She believes that’s because patients get to sleep in their own beds and keep the company of their pets and family members. They’re also protected from hospital-based infections.

But maybe most importantly, Faga says nurses get to jump into their patient’s world at home. They can look for what she calls the “social determinants of health” —things that don’t always show up on a hospital chart.

FAGA: So being able to do a refrigerator biopsy and open up the refrigerator and see what they’re actually eating.

Maybe it’s a physical therapist that’s working with them, but they’re actually practicing getting into and out of their own bathtub, or in and out of their own car. I’m setting up a medication management strategy that involves their own pill box.

Still, “hospital-at-home” patients do face certain risks, given that they’re not, well, in the hospital. Faga says somewhere between 6 and 10 percent of patients end up needing re-admission.

FAGA: Other times if the diagnosis is unclear, we have had to transport them back to the hospital via an ambulance and they may have to stay because of the worsening of their clinical condition.

Once during Mary Ann Smiley’s hospital-at-home stay, she started having what she called a bad episode of shortness of breath. Fortunately, her care team was already on the way to her house for their scheduled visit and was able to jump into action when they arrived. But if they hadn’t been, Smiley says she might have had to call 911.

SMILEY: The next day the doctor told me that he had been pretty concerned about me. That if I hadn’t improved they were thinking about putting me back in the hospital, but I did improve.

Even though I was sick, I’m still saying it was a wonderful experience. I kind of hated to be discharged.

Reporting for WORLD, I’m Maria Baer in Columbus, Ohio.

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