Mass General Brigham easing hospital ER overcrowding with healthcare at home

With an average of 1,500 patients arriving at its emergency rooms daily in early September, and a nearly nine-hour wait for an inpatient room, Mass General Brigham is easing a capacity crunch with expanding at-home health care. Stephen Iannone is known to tell it like it is.”My filter is gone, and my filter broke a long time ago,” Iannone said.That includes talking about his own health struggles. “Years of not eating right and taking liberties with food and whatnot. So, you get into the state of congestive heart failure,” Iannone said.He ended up at in the emergency room at Mass General Brigham in the middle of the state’s ongoing hospital capacity crisis. “You move along slowly in there. You may be there actually in emergency itself for a day or two before you get a bed,” Iannone said.That’s when he was offered another option: go home and get hospital care there. “Anybody that’s in their own space is the happiest. It’s just common sense,” Iannone said.The Home Hospital program at Mass General Brigham has been in place since 2017, but what began as a pilot program is now accelerating to ease the capacity crunch. This month, Home Hospital hit a milestone of 70 beds, making it the largest home hospital in the country.”We treat conditions such as heart disease, chronic obstructive pulmonary disease, and infections. In an environment where patients feel most at ease, they’re home,” said Heather O’Sullivan, president of Healthcare at Home at Mass General Brigham.It’s in-patient hospital-level care at home, with 24/7 monitoring of vitals, multiple visits from a care team every day, and the ability to connect virtually with your doctor. And research shows it’s getting results. A study by Harvard Medical School found that patients needed home hospital care for an average of 6.3 days. And just 6.2% of them ended up needing to enter a physical hospital facility during that time. The mortality rate during home hospitalization was .5%. Iannone says choosing treatment at home was a no-brainer.”I’m in my own home, my own chair, my own bed, my own food, that’s it, my family.How about I got two nurses taking care of me, not 39 other people. How’s that? How good is that?” Iannone said.”The patient is my only focus, period. So, my time with him or her is solely for their benefits. So, if they have any questions, if they need anything done, if they want to communicate with their providers, if they’re having any problems, if they need me to do anything around the home or help them with anything in the home, I am available to do that as well,” said paramedic preceptor Kathryn Dugan.It’s a vital resource for patients and hospital staff with the emergency department often operating in what’s called “capacity disaster” status. That’s when the day starts with more than 45 patients waiting for hospital beds. We just can’t keep up with the growing rate of demand for healthcare services. And this is a nationwide problem. This care model of delivering acute hospital care at home takes advantage of available beds that are out there just within patients’ homes to be able to support the care that they need,” said emergency medicine physician of Mass General Brigham Dr. Stephen Dorner.The model has now been implemented around the country.”It’s now widely adopted by more than 350 hospitals nationally. So, home hospital is supported by both federal and local regulation,” O’Sullivan said.And it’s continuing to expand, aiming to ease the strain on both the hospitals and the patients.”Follow the rules, you’ll get better because the care is unbelievable,” Iannone said.”It’s a more healing environment to be in. Readmission rates to the hospital are lower after home hospitalization when compared to traditional hospitalization,” O’Sullivan said.Mass General Brigham says Home Hospital is also decreasing the infection rate for patients since they’re less exposed to that risk when they’re not in the hospital. The program has now expanded to 71 Massachusetts communities connected to five Mass General Brigham hospitals. They’re also adding the kinds of patients who are eligible, which will soon include new moms who need hypertension care.

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