It started as a pilot program two years ago, now Avera’s Hospital@Home program has been fully launched. It’s a collaboration between Avera McKennan Hospital & University Health Center and Avera@Home that allows patients the opportunity to receive inpatient care in their home rather than the hospital.
“So this actually originated during the pandemic. The entire country was sort of tasked with how do we see patients appropriately? We've had capacity issues, how do we take care of the masses? And how do we do that for patients who are in the hospital? And how do we extend into the community so we can take care of those to decrease morbidity and mortality?” said Magdalene Fiddler, MD, hospitalist physician and Medical Director for Hospital@Home.
“In doing that, we have realized that we're actually pretty good at taking care of patients in their homes and it could be extended beyond just COVID. We see a lot of patients with a lot of different diagnoses. Sure, we can see them in the hospital, but they're more comfortable in their home setting. “Why aren't we doing that?” is the biggest question,” said Fiddler.
“We are a virtual unit of Avera McKennan, just like any other unit that is housed in the building. The benefit really for the hospital is we're opening up beds in the building for those higher acuity patients. And we can provide all of the same services that a hospitalized patient in the building would get. We're checking your vitals. I'm coming to see you in person every day. The nurse is available 24-7 via phone call or via video visit to help administer any medications or triage any problems they're having, just like a call button in the hospital,” said Bethlee Burke, a nurse practitioner with Hospital@Home.
“The biggest benefit for patients is us meeting them where they're at. A lot of the times patients who are chronically ill, they don't want to come to the hospital. So I think when patients see that benefit of, hey, it's my home, my family around me, they know me the best. We listen to that and we really take that into consideration,” said Fiddler.
“Marva came into the hospital through our emergency department after she had been seen by her primary care provider in the clinic and she'd been experiencing some shortness of breath and fatigue. I got notified with a consult referral,” said Burke.
“They asked me if I'd like to do this hospital home care and I really like the idea because this way I could be home in my own environment and sleep in my own bed,” said Marva Jean Chevalier, a patient in the program who was dealing with a respiratory illness.
“Essentially my role is to see patients in their home, typically like a physician or nurse practitioner or physician's assistant would see them in the hospital. So I round every day on our patients to do assessments and exams,” said Burke.
“And then they do your vitals. They make sure that they have your medication at the right time. They drew blood to make sure things were going well!” said Chevalier.
“We do a daily video visit with our attending hospitalist at Avera McKennan and so they are able to still see the patient every day. I work collaboratively with them to discuss my assessment and exam and then we form a plan of care together, just like we do in the hospital,” said Burke.
“My first question when I get on camera, I ask them, 'How do you feel this experience has changed your life?' The one biggest thing everybody tells me is like, 'Oh my gosh, I got a good night of sleep.' You cannot beat that,” said Fiddler.
“They're moving around more in their home versus in that small hospital room. So all of this really helps with healing faster. And then from our perspective as a provider and my nursing staff, we're able to actually see what they're doing in their home to be able to help them be successful when we do discharge them,” said Burke.
“Patients are always offering us coffee or snacks and they want us to come in and sit down at the table and chat with them or they have family that comes over and visits while we're there too and they're very, very happy to be able to have that interaction that they may not have been able to have in the building,” said Burke.
“The outcomes for our patients are definitely really, really good. Our patient satisfaction is extremely high because we're in their own home and they're in their own home, said Burke.
“I loved being home in my own environment and stuff and being able to have my own bed and facilities around you. I didn't have to do anything but rest. I couldn't have asked for anything better,” said Chevalier.
Currently, for patients to be eligible for Hospital@Home, they must have a care plan that would work in the home setting. They also need to live within a 30-mile radius of Avera McKennan if they should have a change in status.
