The Problem
Like most health systems across the United States, Pinehurst, North Carolina-based FirstHealth of the Carolinas has challenges with bed capacity and is always working on new and innovative ways to increase it in a safe and financially responsible way.
Proposal
The Observation at Home (OAH) program is designed to increase bed capacity across the health system by discharging stable patients who can be managed at home via the program but would otherwise need to have stayed in the hospital if taken care of by traditional medicine.
Meeting the Challenge
"We complete our telemedicine video visits using the Epic EHR," said Stephen Kapa, administrative director of telehealth services at FirstHealth of the Carolinas. "All information is relayed through that platform. For the patients who transition to the VCAH program, we use Health Recovery Solutions blood pressure cuffs and pulse oximeters. The patients download an app from the vendor on their phone and can upload their readings from their monitoring devices through the app.
Results
"One of our biggest achievements in the past 14 months has to be the average daily census in the program," Kapa reported. "Our fiscal year runs from October to October. In the first week of October of 2023, our average daily census was under two. We have had our peaks and troughs over the year, but the trend line has always been positive. In the last week of our fiscal year, we averaged 13 patients per day.
Advice for Others
"My advice is twofold," Kapa said. "Keep things as simple as possible and be persistent. As you can see by the growth of our average daily census, it didn’t grow overnight nor on its own. You need to be very persistent in delivering your message about the program to all groups, especially providers and discharge planners.
Conclusion
FirstHealth of the Carolinas has successfully implemented the OAH program to increase bed capacity and reduce readmissions. The program has shown promising results, with an average daily census of 13 patients and a 30-day readmission rate of under 10%. The program has also received positive feedback from patients and families who appreciate the ability to receive care safely at home.
FAQs
Q: What is the Observation at Home (OAH) program?
A: The OAH program is a telemedicine-based program that allows stable patients to receive care at home instead of in a hospital.
Q: How does the OAH program work?
A: The program involves a paramedic visiting the patient’s home, performing an in-person assessment, and connecting with a provider via tele-video to complete the remainder of the visit.
Q: What types of patients are eligible for the OAH program?
A: Patients with diagnoses such as CHF, COPD, pneumonia, influenza, COVID-19, asthma, need for IV antibiotics, cellulitis rechecks, and abdominal pain rechecks are eligible for the program.
Q: How does the OAH program impact bed capacity?
A: The program increases bed capacity by discharging stable patients who can be managed at home, freeing up hospital beds for more critically ill patients.
Q: What are the benefits of the OAH program?
A: The program has shown promising results, including a 30-day readmission rate of under 10%, and has received positive feedback from patients and families who appreciate the ability to receive care safely at home.
