VIRTUAL CARE

The Future of Virtual Health: The ‘Hospital at Home’

As Atrium Health braced for a surge of coronavirus patients back in March, strategists knew they needed to try something different or face the prospect of becoming overwhelmed.

On most days prior to the pandemic, the Charlotte-based hospital system already exceeded its inpatient bed capacity at hospitals in its core service area. Leaders were anticipating needing upward of 50 percent additional inpatient bed capacity to address an increase in cases at those hospitals with little wiggle room to spare.

During those early days, Atrium came up with the idea of a “virtual hospital” to treat COVID-19 patients at home and free up hospital space. It took the 45-hospital system just 10 days to implement the concept in the spring. By August, the service had treated nearly 16,000 patients through the program, and only about 3 percent became inpatients.

“As an organization, we always thought about ways that we could deliver care in a virtual environment, but COVID-19 was definitely the catalyst for creating our virtual hospital,” said Jhaymee Tynan, assistant vice president of integration at Atrium. “We asked ourselves: How can we use innovation to make sure that patients can recover in the comfort of their own homes, without spending time in a physical hospital?”

Tynan and Scott Rissmiller, M.D., Atrium’s chief physician executive, are set to discuss the new program as part of Navigating a New Reality, a virtual conference from SHSMD and the AHA Center for Health Innovation focused on COVID-19, from recovery to rebuilding. The event will be Sept. 14-16 and offer attendees three months of on-demand access to its content.

During the session, the duo will explore the integrated applications of this new approach for health care leaders and strategists. Tynan said they’ll dive into how the organization quickly put the new care model in play, and share some of the early successes. She “absolutely” believes other hospitals could replicate the offering elsewhere, and that the model will prove useful during future crises.

“You have to have the right infrastructure in place and a very strong provider network to be able to deploy nurses into patients’ homes,” Tynan said. “But I do think that the model is replicable, provided that you’ve thought through your protocols and processes, and you have the right pieces in place.”

How it Works

The COVID-19 Virtual Hospital operates with two separate “floors”—one for “observation” patients and the other for acute care patients. Typically, the process starts with a community member phoning or visiting an Atrium facility to discuss their symptoms. Patients suspected of having COVID-19 are tested and those with a positive result are assessed by a provider. Those with severe symptoms are typically admitted to the emergency room of an actual hospital and those with minor, moderate or no symptoms are eligible for the virtual hospital program and assigned to the “observation floor” or the “acute care floor.”

Virtual acute care patients receive a kit that includes a blood pressure monitor, pulse oximeter, thermometer and detailed instructions for at-home care. They are tasked with monitoring and logging their vital signs throughout the day and engaging in daily check-in calls. "Through 24-hour monitoring, we can spot any trends or worsening symptoms and intervene early before it becomes an emergency,” Rissmiller said. "It also allows the hospital system to reserve critical resources for those who truly need them the most,” he added.

Patients on the virtual observation floor receive a telephone assessment every other day from a nurse, along with access to Atrium’s GetWell Loop that provides regular engagement and feedback. Providers also make in-home visits for care and Atrium set up a 24/7 phone line for any questions from patients on either hospital “floor.”

Atrium’s messaging strategy has been key thus far to the initiative’s effectiveness, including providing culturally relevant materials for the large Spanish-speaking community in the Charlotte area. Atrium has also focused on providing clear instructions about testing and treatment. 

About 95 percent of Atrium’s COVID-positive patients have been treated by the virtual hospital as of August. Tynan credits early leadership support, and cross-training of staff on the virtual hospital to allow for flexibility as the pandemic has evolved, as key factors to their success.

Clearly, the genie is out of the bottle when it comes to virtual care—with patients now demanding these types of convenient care services—and Tynan believes models such as this will continue to proliferate throughout the pandemic and beyond. “I think it’s here to stay,” she said.

 

This article features interviews with:

Jhaymee Tynan
Assistant Vice President, Integration
Atrium Health
Charlotte, North Carolina

Scott Rissmiller, M.D.
Executive Vice President and Chief Physician Executive
Atrium Health
Charlotte, North Carolina

Image credits: istockphoto.com/Geber86