Nemours Children’s Health has launched an innovative hospital-at-home program for pediatric patients—the first in the country designed by a freestanding children’s hospital.
In the six months since the launch of the Advanced Care at Home program, it has expanded from five patients per day to 75. In a 30-day pilot period, the at-home care model averted 27 readmissions, prevented 91 ER visits and returned 177 hospital days to families.
The program is a 24/7 clinical virtual model designed for children who are medically stable but require additional medical care and oversight. One common condition that the program treats is infants who need to learn to feed in the hospital after a surgery. The program could provide a Bluetooth-enabled weight scale and pulse oximeter for parents to use before and after each feeding, to ensure they are meeting nutritional requirements.
Nemours said 75% of patients in the program fall under a complex care umbrella, or have more than one problem, and are dependent on technology like feeding tubes.
Nemours can customize the care program for each child, such as tailoring the frequency of telehealth and in-person visits. The children’s hospital also provides education and virtual guidance to families with a child in the program.
Children recover better at home, Chris Beaty, vice president of operational innovation at Nemours, said in an interview. The program also significantly reduces the burden families face when a child is hospitalized, such as transportation, missing work and paying for child care for other children.
“What we know is kids do better at home, period. For various reasons ... whether it's kind of just sleeping in their own bed, eating their own food, interacting and socializing with their with their family and their siblings, they're more mobile,” Beaty explained. “All of those things matter when it comes to healing.”
Nemours Children’s Health operates two hospitals, one in Orlando, Fla. and the other in Wilmington, Del. The hospital system has had a clinical logistics center, a remote center for clinical oversight, for over 12 years. It also has a virtual nursing program.
The system realized it could leverage these teams to metaphorically “turn the camera around” and monitor children in their homes as well as in the hospital. The infrastructure allows for 24/7 monitoring of children, which helps families trust the decentralized model.
“I think ... probably one of the most comforting things is our families that are enrolled in this program know that they can reach us 24/7 and we can escalate to either a nurse or to a provider,” Jane Mericle, executive vice president, enterprise chief nursing executive and chief patient operations officer at Nemours, said. “Sometimes we've even beamed in a specialist.”
Nemours ran a pilot for 30 days in Orlando, where it has since deployed the program. The months-long conceptualization and pre-testing of the model allowed for a quick and successful deployment in the pilot phase, Beaty explained. Nemours simulated the entire patient journey with the simulation program at the hospital.
The system piloted the program with pediatric patients who were already cleared to be discharged from the hospital. They monitored the patients for an additional period to check how the remote monitoring technology functioned, tested the escalation pathways and ensured parents knew who to call if a problem arose.
“Between virtual nursing, telehealth visits from providers, it provides a platform for us to be able to have medically stable children move from the hospital, get discharged, and then be in the home,” Mericle said. “When children have been in the hospital, either long term or [for] procedures, it can be pretty anxiety-producing to make that transition. So what's beautiful about this is it's a bridge from hospital to home.”
Nemours works with durable medical equipment companies and home care agencies to source the technology needed for the remote monitoring of their condition. Depending on the child’s situation, Nemours can provide technology to the family.
It also leverages Epic to conduct the telehealth visits and allows families to message the clinical team through Epic MyChart’s texting capability. All clinical information from the advanced care-at-home program is easily logged in Epic.
Nemours is currently being paid for the program by billing the ambulatory telehealth visits conducted by providers during the at-home stay. However, the system is in talks with payers to engage in innovative payment models for the program, which can improve the quality and safety of hospital care while decreasing length of stay, readmissions and emergency room visits.
In December, Nemours hopes to expand the program to include patients at its Wilmington hospital. It also plans to add a jaundice care program for infants born with the condition to receive light therapy at home for about 72 hours before transitioning back to primary care.