Home Sweet Hospital

Roper St. Francis Healthcare leads an effort to deliver acute hospital care directly to patients’ homes

WRITTEN BY Lauren B. Johnson

Roper St. Francis Healthcare, with support from The Duke Endowment, is quite literally redefining acute care. In an effort to treat patients where they live, the not-for-profit health system is working with legislators to rewrite the legal definition of a hospital. “In South Carolina, strict language from the 1970s says that a healthcare facility is a brick-and-mortar building,” explains Dr. Ryan Connolly, medical director of Hospital at Home. On the forefront of virtual hospital care in the Carolinas, Roper St. Francis Healthcare hopes that the dated definition will be revised early this year. “This is an opportunity to deliver better access to care.”

Dr. Ryan Connolly

Developed in the late ’90s at Johns Hopkins University School of Medicine, the hospital-at-home model has swiftly gained momentum over the last two years. “The COVID-19 pandemic jump-started the virtual care trend by about a decade,” Dr. Connolly observes. Early pilots, like that at New York’s Mount Sinai, produced strong evidence of positive impacts on length of stay, clinical outcomes, cost and more. “The service also frees up needed bed space,” Dr. Connolly says. Here, he previews Hospital at Home ahead of the program’s anticipated launch later this year

HOUSE CALLS (HC): Who will be eligible?
Dr. Ryan Connolly (RC):
The Centers for Medicare & Medicaid Services thinks there are 60-plus conditions that can be treated at home, diagnoses like congenital heart disease, COPD, pneumonia, dehydration and cellulitis. That’s about 30 percent of patients currently treated in our hospitals.

HC: How can you ensure at-home patients receive the same quality care given inpatients?
Before being sent home, they’ll receive a full physical. Once at home, they’ll have virtual access to a doctor at any time. We’re also able to provide everything you would in a hospital setting, including daily in-person visits by a nurse, 24-hour monitoring, in-house pharmacy medications, IV drips and physical and occupational therapies. Labs and x-rays can be done right at the house, and patients can even have meals delivered.

HC: Beyond just comfort, what benefits should patients expect from a home hospital stay?
At home, patients are in a familiar environment, and they only have nurse visits once a day (unlike at the hospital, where patients have their vitals checked every four hours or more, even if they must be woken up to do so). The result is a reduced risk of falls. The model has also shown decreases in readmissions, infections, mortality rates and cost.

HC: What technology will be used?
Patients receive a Bluetooth-enabled tablet and biometric peripherals. Every two to four hours, they’ll check their vitals using a blood pressure cuff, pulse oximeter and scale, if needed. (A virtual stethoscope that lets us hear a person’s heartbeat in real time is also being developed.) The equipment sends data directly to the tablet as well as our remote monitoring hub. Through phone calls, video chat and text, we can communicate with patients—and them with us—24 hours a day. The tablets are also equipped with a cellular connection, so patients won’t need Wi-Fi.

HC: How are you preparing for the Hospital at Home launch?
We’re fine-tuning the logistics of our care plans and practicing remote monitoring on ourselves to test out the technology. We’re also coordinating with insurance companies and legislators for approval to reimburse the service.