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Hospital Sending COVID Patients ‘Home Where They Can Heal’

"This allows us to send patients home where they can heal. And it also helps us make sure that, as our hospitals come to a high capacity, we have the support available to make sure that anybody who needs care can find that in one of our facilities."

by Audrey Dutton, The Idaho Statesman / December 14, 2020
(TNS) - Dec. 14—Ken Miller was feeling crummy. The 66-year-old from Star was going through cancer treatment. Now, he had a fever. His doctor thought it might be a bad reaction to chemotherapy, so he went to the emergency room at St. Luke's.
It was July, and it turned out that Miller was one of many Treasure Valley residents to catch COVID-19 during the summer surge. He spent the next few days in the hospital.
When his condition improved, "they said it's looking good, we're going to send you home," Miller said. The doctor gave him a prescription for oxygen — and he also got a kit with an iPad, a blood pressure cuff, a scale and a pulse oximeter to measure his blood oxygen levels and heart rate.
Miller was one of the early COVID-19 patients to be placed on St. Luke's Health System's remote patient monitoring program — an approach St. Luke's started more than three years ago and is now ramping up to help manage hospital capacity and COVID-19 recovery.
An extra tool in Idaho's pandemic toolbox
The program had about 175 patients at a time as of last week, up from about 50 a few weeks ago. With additional staff, officials expect to have room for 600 patients within a month, and eventually up to 1,500 patients at a time, said Krista Stadler, senior director of telehealth and virtual care at St. Luke's Health System.
"This allows us to send patients home where they can heal," Stadler said. "And it also helps us make sure that, as our hospitals come to a high capacity, we have the support available to make sure that anybody who needs care can find that in one of our facilities."
Stadler hopes it will be one piece of a bridge that gets Idaho to the other side of the pandemic without having to resort to "crisis standards of care," when hospitals are too overwhelmed. (But she, like other health care leaders, stressed that Idahoans are their own best protectors from the pandemic.)
"This has a benefit to the community and our patients, because they're going to be able to recover with the support of a care team in their home," Stadler said. "But it also is helping our community because we have significant concerns about our capacity to care for people during this population health emergency. And this is one lever that we are fast tracking. We had plans to do this before, but we are fast tracking it, to be able to ensure that we have a bed available when a patient needs us."
From the hospital to home
Patients check in with the tablet twice a day, answering questions and prompts. The kit doesn't need an internet connection; it uses cellular networks. Patients in their 30s and as old as 104 have used the devices, said Jason Blomquist, a registered nurse and St. Luke's director of telehealth and virtual care services.
One nurse can monitor as many as 100 patients. It allows people to recover at home, frees up hospital beds and shortens costly hospital stays, according to St. Luke's. Health care providers can check for signs that a patient is getting worse or better.
After the pandemic hit Idaho, St. Luke's saw an opportunity to use it with COVID-19 patients.
St. Luke's has used the program for eight months to do "early and safe discharge home" for COVID-19 patients who reach a point where they're not out of the woods — they need someone watching their vital signs and health condition — but they aren't sick enough to need around-the-clock hospital care anymore, health system officials said.
While being in a hospital can be life-saving, it also can be exhausting for patients. Nurses, physicians and therapists have to check vital signs, run tests or administer medications at all hours. On top of that, the pandemic means family and friends can't stop by to visit, and being alone with a serious health condition can be frightening and stressful.
When patients can safely go home early, it allows them to recover in a more comfortable setting, officials said. Miller agreed.
"Just even getting home from (a few days in the hospital), it was like I was on leave from being in the Army or something," he said.
For the two days after St. Luke's sent him home, Miller checked in virtually twice a day.
"One of the days, I called and said, 'I'm struggling to keep enough oxygen in my body,'" he said. One of the nurses called the on-call doctor and got back to Miller. "She said, 'You need to just go to the ER and tell them what's happening,' so I did that."
Miller needed to be admitted again. He spent several days in the hospital, going home Aug. 1 with more home monitoring. He has been steadily improving since, he said.
Starting Tuesday, the program will be open to all adult patients hospitalized for congestive heart failure, chronic obstructive pulmonary disease (COPD), Type 2 diabetes, pneumonia or sepsis in Boise, Meridian, Nampa and Magic Valley hospitals. It will only be offered for patients who are well enough to go home early with remote monitoring, St. Luke's said.
Those patients are monitored at least 32 days and up to 60 days.
For COVID-19 patients, it only takes nine to 12 days of monitoring before health care providers can tell if a patient is ready to leave the program, Blomquist said.
"We are finding that they either have some issues that present themselves relatively quickly, or they recover," Blomquist said.
As for Miller, he is still recovering from COVID-19. For a long time, it hurt to breathe, and he couldn't take deep breaths.
"I did go to a lung doctor, and they said, 'You're in the normal range,'" he said. "Normal doesn't get you to the top of Mount Borah! But I have every reason to be optimistic about the cancer, and every reason to be optimistic about returning to health someday."
(c)2020 The Idaho Statesman (Boise, Idaho)
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