Hospital at Home
Supporting patients on early discharge from acute care
With a growing backlog of elective surgery and fears that winter pressures could destabilise any efforts being made to tackle waiting lists, NHS resources are under pressure. This in turn puts hospital discharges firmly in the spotlight. We know that for certain patients, recovery at home can be beneficial1 and that it avoids lengthy hospital stays, freeing up hospital resources. However, clinicians responsible for safe and effective discharge from hospital want to ensure that patients can be routinely monitored for any changes in their clinical condition. This is important for patients who are discharged from hospital following a Covid-19 infection. Connecting discharged patients seamlessly to health and care professionals increases confidence in allowing people to recover at home.
To get a better understanding of the benefits for patients and clinicians responsible for their care we have highlighted the example of 63 year old Margaret who was admitted to hospital following difficulty breathing after contracting Covid-19. Fortunately, effective treatment saved her life and having spent six weeks in hospital she has been discharged home.
The doctors responsible for Margaret’s discharge from hospital were concerned about her slow resting heart rate and potential complications, but she was very keen to go home. So, her doctors carried out a risk assessment and all parties agreed she could recover at home where she would be monitored using appropriate technology.
A tailored package of devices was chosen for Margaret’s care which included a hospital provisioned pulse oximeter, her own smart watch and Amazon Alexa. These connected devices were set up to monitor her condition and send alerts to health and care professionals if given thresholds for a range of health indicators were exceeded.
Using connected technology, health and care professionals can be notified immediately should there be any change in her wellbeing. They can check in on her using any of the communication devices to see how she is feeling.
Margaret experienced an episode recently after she had been doing some gardening and then went upstairs – her heart rate increased, and an alert was created. A nurse practitioner at her local GP practice called within an hour to check on Margaret and advised her to rest until her heart rate had reduced.
By having a connected real time monitoring solution Margaret is reassured by the knowledge that should her condition change, the right people will know what is happening and can take appropriate action according to a specific set of personalised thresholds.
Amazon Alexa is fully integrated into the system. Here we see a transcript where Margaret has communicated via Alexa that she is feeling unwell.
Margaret’s record detailing her vitals, devices in use and contact information. Here the clinician can access notes from check-ups or appointments with the patient. As Margaret’s heart rate increases, the clinician gets an alert warning and is able to directly contact Margaret to offer help.
Enabling patients to recover at home can also improve outcomes. Research evidence suggests that patients with chronic disease who are sent home to recover as part of a hospital at home programme are less likely to be readmitted to hospital2.
As for health and care staff, they can be confident that any signs of deteriorating health will be picked up after a patient has been discharged from hospital. Connected real time monitoring means less time is spent on in-person visits and it can also help to improve clinical documentation which is vital for the audit trail.
There are also significant benefits for the health and care system. Virtual wards for discharged Covid-19 patients who are monitored using devices such as pulse oximeters have been shown to be effective in keeping track of oxygen levels and reducing readmission3. In terms of health system resources, home oximetry with virtual ward monitoring has been implemented inexpensively at scale to take pressure off overstretched hospital services.
Connecting patients via remote monitoring devices has many benefits for patients, health and care staff and the system. At a time when resources are stretched and NHS staff are still recovering from worst of the Covid-19 pandemic, it is time to make the most of the technology that is available to us.