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ED Patients: Partnering with Home-Based Care to Fill Gaps in Care

The emergency department (ED) is the hospital’s front door, providing over 70% of all hospital admissions. How can home-based care providers partner with EDs?

One example is Penn Medical which piloted an at-home discharge service to shorten hospital stays and prevent hospital readmissions by providing emergency department patients with support at home. The Path program (Practical Alternative to Hospitalization) offers ED clinicians an outpatient care pathway for patients initially designated for inpatient admission or observation to prevent rehospitalization by providing home-based patient support after emergency care. According to a study published in Healthcare, Penn Medicine successfully prevented hospital readmissions in nine out of 10 emergency department patients.

The PATH program conducted a 14-day trial for the service in December 2019. The program cut emergency department wait times by an average of 8 hours for enrollees. PATH enrollees also had hospital stays two days shorter, on average.

“The culture is shifting where we realize that hospitalization is not always the best option for patients – particularly patients with chronic illness, ”Austin Kilaru, MD, an emergency physician at Penn Medicine and one of the study’s lead authors said in a press release. “We need to find better ways of helping patients not just get healthy in a hospital but stay healthy at home – whenever they are ready to be there.”

The PATH Model

The PATH team deployed an advanced practice provider (APP) to screen hospital bed requests to determine which patients met the criteria for discharge to home. They considered the reasons for the patient’s visit, their vital signs, medical history, and social support systems. If the patient’s emergency physician agreed to enroll in PATH, the APP developed a comprehensive plan in partnership with that physician and the patient’s care team.

Patients enrolled in the program received personalized support at home. This included phone calls or text messages to assess their status, coordination of outpatient appointments, and additional diagnostic testing. This tailored plan also includes home nursing visits, physical or occupational therapy, or transportation assistance.

Fifty-two patients met PATH’s eligibility requirements (of 199 possible patients). More than half of them, 30, enrolled in the program, with most of the remainder still requiring hospitalization at the discretion of the treating emergency physician.

Many patients were enrolled in the program for common conditions, such as chest pain, high blood sugar, and congestive heart failure. The study authors estimate that, on average, patients would have spent more than two days in the hospital and eight additional hours waiting in the emergency department. Only four patients needed to return to the hospital within 30 days of their initial visit when the PATH team recognized that patients again required hospital-level care.

“Another concern in this pilot was that patients might have worsening illness at home and need to return to the emergency department,” Kilaru said. “Fortunately, our patients did well and had good outcomes – even 30 days later. We created careful safeguards to select the right patients, so while a few patients did need to return, it was not unexpected, and we could help communicate key medical and social issues to the emergency department and hospital teams.”

“This could be promising for payers, health systems, and patients alike,” Resnick said. “Payers benefit by having their members avoid costly inpatient stays. Patients benefit by having more safe days at home. And hospitals with busy emergency departments and full beds benefit by freeing up resources that can be utilized by the most sick and complex patients.”

In conclusion, hospital emergency departments can partner with home health agencies to provide comprehensive, compassionate care to patients after discharge. Patients can recover comfortably from illness, injury, or surgery with adequate home healthcare support and reduced hospitalization risks. Home healthcare workers collaborate with hospitals to carry out follow-up care and coordinate communications, leading to better patient outcomes and a reduction in the rates of hospital readmission.

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