Innovation is often born out of necessity. The challenges brought on by COVID-19 forced many medical institutions to adapt quickly, among them Tampa General Hospital (TGH), which launched its Hospital at Home program during the pandemic. Now, what started as a way to manage that crisis has permanently transformed the facility’s care.
With Hospital at Home (also called TGH at Home), patients who meet certain medical criteria can elect to recover from an illness in their own living space instead of spending extra time in an inpatient hospital facility. They receive daily visits from healthcare providers, take part in virtual visits, and are remotely monitored around-the-clock using wireless devices that capture and transmit their vital signs.
Hospital at Home was made possible through a waiver introduced by the Centers for Medicare & Medicaid Services at the start of the pandemic. According to Peter Chang, MD, the vice-president of healthcare design at TGH, being granted the waiver helped the hospital to conduct in-home care at a level that compares with what it offers on-site.
Importantly, the waiver also permits hospitals to have the at-home care reimbursed. “That really allowed us the opening to create something like this,” said Dr. Chang. “We ended up applying for our waiver in 2021, and began the program in mid-2022.”
TGH’s program is different from a typical home healthcare arrangement that provides discharged patients with home visits once or twice a week. Patients enrolled in Hospital at Home receive two visits from a registered nurse or other clinical team member every day, “because they would normally meet the criteria to be in a hospital,” said Dr. Chang
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Going From Hospital to Hospital at Home
As someone living with stage 4 breast cancer, April Bennett Cabral is no stranger to hospital stays. “I’m a cancer patient, so I’m basically a professional patient,” said the St. Petersburg resident. Cabral knows it can be hard to sleep well and feel comfortable in a hospital, so she felt grateful when she learned she could get high-quality care at home.
Cabral ended up in the hospital last January when she developed a fever after undergoing a chemotherapy session. Usually, if she felt ill or feverish, her healthcare provider would tell her to take a COVID test before coming into the office, just to rule out the possibility of the virus. Cabral didn’t think she had it because she didn’t have any respiratory symptoms—but when she took the test, it came up positive.
Cabral’s healthcare provider directed her to go to TGH, which then admitted her with a fever and a high resting heart rate of 150. It took about two-and-a-half days in the hospital for her heart rate to return to normal, and she still needed to undergo an IV treatment for three days, which typically requires an inpatient stay with supervision.
To her relief, Cabral was offered the chance to participate in Hospital at Home. “I, of course, said yes,” she remembered. Cabral was fortunate in that she lived just 25 minutes from TGH, putting her squarely within the 30-minute range her care team required to respond quickly and transport her back to the hospital if needed.
TGH staff called a ride-hailing company to take Cabral home, and a nurse arrived to take her vitals and set up an IV in her living room. Soon Cabral found herself with the same monitoring services and equipment that she would have had at the hospital. “I was very thankful to be able to sleep in my own bed and walk around my own house,” she said.
Innovative Hospital: UCLA Health
Back to Basics, With a Modern Twist
TGH’s Hospital at Home program is a nod to the years when healthcare providers made house calls—but with the added benefit of advanced technology.
Under Hospital at Home, providers gain insight into their patients’ daily activities and lifestyle habits that they normally wouldn’t have at a medical institution. For example, they may see that an older patient isn’t taking their daily medication correctly, so they may offer targeted instruction around scheduling, dosage, and pillbox storage.
New technology enables constant monitoring. Those who participate in Hospital at Home wear a Remote Patient Monitoring device on their chests that tracks their blood pressure, pulse, temperature, and other vital signs, uploading the data via Bluetooth to a tablet connected to the cloud, where the hospital accesses it. There’s also a separate telehealth platform that allows for remote exams and virtual visits with providers.
Among people who use Medicare, hospital readmission rates usually range from 10 to 20% (depending on the diagnosis), said Dr. Chang. By comparison, just one of the 70 patients who has used Hospital at Home has been readmitted. Dr. Change attributes this in part to the observations healthcare providers are able to make when seeing patients in their own homes, and the transition care they provide to them at discharge.
As Dr. Chang thinks about the future, he hopes that the data Hospital at Home is able to collect on the reduction of readmissions, improvement in patient experience, and lowering of costs will allow it and other similar programs to expand in the United States.
“We don’t have to build a hospital to take care of more patients,” he emphasized.
