Hospitals needed to rapidly find more beds due to COVID-19. Tufts Medical Center looked to patients' homes

Tufts Medical Center is exploring the option of providing hospital-level care at home, which could be an important alternative as communities begin to reopen. (Getty/Nikola Stojadinovic)

Among the many lessons from the COVID-19 pandemic: Hospitals need more flexibility when it comes to finding beds for patients.

Watching as hospitals overseas were overwhelmed with patients, health officials in the U.S. scrambled to plan for the worst. They cut elective care and stood up field hospitals to handle the expected crush of patients sick with COVID-19 among their typical patient volumes.

Instead, many saw that capacity go largely unused.

"The vast majority of hospitals are well above their normal ICU census, but have been able to manage," said Tufts CEO Michael Apkon, speaking specifically about Massachusetts' hospitals.

Meanwhile, hospitals around the country report that patients seem to be avoiding or deferring care for non-COVID-19 health concerns, driving volumes lower. This recently prompted Boston's hospitals to run a public service announcement letting patients know it's still safe to seek care for urgent health concerns.

It's an example of just how difficult it has been for health systems to gauge the proper response to the virus.

So, as the rush to create capacity centered on reworking hospital units or quickly building out field hospitals, Tufts recently turned to another answer: offering hospital-level acute care in patients' homes. 

The idea is that patients with COVID-19 at low risk for deterioration could get their care at home. At Tufts—which seems to be hitting its peak this week, Apkon said—that could help create a flexible way to scale care for potential future surges in COVID-19 cases.

But it could also be the secret to convincing patients with non-COVID-19 health concerns to come back. 

"It’s another arrow in the quiver; another tool to rely on," Apkon told FierceHealthcare. "It may make it more feasible for us to bring back care sooner for some of the care that’s been deferred to have people stay shorter times in the hospital." 

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The health system began exploring the possibilities of a virtual hospital model late last summer with Medically Home, a company that is also based in Boston. The idea is to offer hospital-level care in the home. 

At the time, the interest was in creating capacity for the hospital without needing to build an expensive new patient tower, Apkon said. 

But when COVID-19 hit, the idea took on new urgency as officials realized some patients needed some medical supervision but could safely be treated at home, freeing up beds for more critically ill patients. 

"As a society, as a culture, as an economy, we’ve been tied to this idea that to deliver a service, we needed an asset like a building. Universities needed gigantic campuses, retail stores needed malls, and high acuity health care needed hospitals,” said Raphael Rakowski, CEO of Medically Home. “We now recognize we have to be more flexible in how we deliver services."

To deliver hospital-level care in the home, Medically Home has to set up a number of technology elements quickly. 

"If you think about being admitted to the hospital, in the physical room itself, you have a bed, you have oxygen, you have other equipment. But more importantly, you have access to the nursing station and physicians checking your chart," Rakowski said.

In less than an hour, the group sets up technology including an iPad and other platforms to allow the group to monitor the patient's vitals in real time, see the patient and communicate with the patient as well as with the family. The team also sets up what they've dubbed a "bat phone" which allows the family and the patient immediate access to the clinical team and ensures there is backup power and backup cell signals, as well as any medication or durable equipment. 

In early April, Tufts was able to put protocols in place to begin offering the option for hospital care at home. They have been able to discharge five patients to their homes for care so far. 

"We think it's a compelling alternative that will allow us to keep people safe and deliver the care that's necessary while we continue to deal with this pandemic," Apkon said. 

Next steps

As major health systems reported earnings this week, they all said they were eager to begin resuming surgeries in markets around the country. 

But, each said, no one is sure what the future will bring.

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"There's a lot of uncertainty about what comes next. Will there be another wave? Will hospitals be more prepared? Will the states be more prepared?" Rakowski said. 

Apkon said the home care option will be an important alternative. 

"As we think about coming back and restoring normal operations, we believe that there is going to be a bit of a roller coaster alternating between the accelerator and the brakes with a substantial chance that there is a resurgence of enough activity that we’re stressed again," he said.