A major health system was able to expand its hospital capacity in the early days of the COVID-19 emergency, thanks to a largely virtual hospital-at-home program. Its story — highlighted in the journal Annals of Internal Medicine — reflects broader trends in the home-based care field.
Starting in the spring, Charlotte, North Carolina-based Atrium Health, one of the nation’s largest integrated health systems, implemented a system that allowed patients with less severe COVID-19 cases to opt into an at-home care option.
Atrium Health oversees 50 hospitals, 44 urgent care centers and 45 emergency centers spanning three states. The health system has about 14 million patient encounters annually.
“Virtual hospital programs have the potential to provide health systems with additional in-patient capacity during the COVID-19 pandemic and beyond,” Kranthi Sitammagari, a physician from the Atrium Health Hospitalist Group, wrote in the Annals of Internal Medicine study.
Patients were first tested for COVID-19 across Atrium’s network of emergency departments, primary care clinics, urgent care centers and external testing sites. Those who tested positive were given the choice of being cared for virtually at home or in the hospital, if their symptoms were severe enough.
Virtual options included Atrium’s home-based virtual observation unit (VOU) or its virtual acute care unit (VACU).
The VOU was designated for low-acuity patients who could be managed remotely with daily check-ins from RNs. The VACU was for patients with mild-to-moderate symptoms who would otherwise be sick enough to be admitted to the hospital.
VACU patients were set up with a hospital bed, medical equipment and videoconferencing tools within 24 hours. Additional follow-up services included oxygen assistance, medical treatments, daily virtual physician rounds, vital-sign monitoring, twice-daily nursing assessments and more.
Nearly every single patient who tested positive picked Atrium’s hospital-at-home option when given the choice, Stephanie Murphy, the medical director of the program, told Medscape Medical News.
From March 23 to May 7, Atrium treated 1,477 patients at home after receiving a COVID-19 diagnosis. That accounted for 64% of all of its COVID-19 patients from that time period.
On average, the 1,477 patients “stayed” in the hospital-at-home settings — the VOU, VACU or both — for 11 days. Of the 1,293 patients that received care in the VOU only, just 3% required in-patient hospitalization.
Patients admitted to the VACU most often received supplemental oxygen or a respiratory inhaler. Other resources provided from Atrium were intravenous fluids and antibiotics, when appropriate.
Even when a patient’s symptoms increased to a point where their care plan needed to be intensified, patients mostly elected to keep receiving that care at home. A part of the reason for that, Murphy told Medscape Medical News, was because they wanted their loved ones to be able to visit them.
Hospital-at-home models have become increasingly popular. A slew of health care organizations, including DispatchHealth, BayCare and Lifesprk, have either launched hospital-at-home programs on their own or facilitated them in the last year.
Programs will likely continue to pop up moving forward, too, as recent COVID-19 surges across the country have put hospitals back into crisis mode.
In the week spanning from Nov. 4 to Nov. 11, nearly 20% of American hospitals dealt with staffing shortages. That number increased this week, according to data provided to The Atlantic by the U.S. Department of Health and Human Services (HHS).