Community paramedics can play a crucial role in hospital-at-home programs by bringing their advanced assessment skills directly to the patient’s home. Trained providers can monitor patient safety needs, conduct regular in-person physical evaluations, facilitate remote access to physicians, and help install and monitor advanced wearable technology.
Some people might be tempted to dismiss hospital-level care at home at the outset. This is understandable. However, after reading this article, even if you’re a hospital-at-home skeptic, I believe you’ll see that these programs have real potential to expand in the coming years.
Where Do Community Paramedics Fit in Hospital-at-Home Programs?
Community paramedics fit into hospital-at-home programs as the in-person clinical presence the model needs: they support the safety assessment that selects appropriate patients, perform daily or twice-daily evaluations, facilitate remote physician access through telehealth, install and monitor wearable devices, and coordinate with primary care to reduce cost and improve outcomes. Technology finally makes acute hospital care at home practical, and community paramedics make it safe.
Key Takeaways
- Hospital-at-home is an old idea that technology only recently made practical.
- Patient selection through a safety committee is where the model succeeds or fails.
- Daily in-person evaluation is the community paramedic’s core contribution.
- Telehealth and wearables extend the physician into the home.
How Does MIH-CP Assist Hospital-at-Home Programs?
Hospital-at-home programs are exactly what they sound like. They are programs that create a hospital-like environment in a patient’s home, enabling advanced evaluation and treatment.
For those new to the idea of hospital-at-home programs, keep in mind that they are not intended to replace hospitals; rather, their goal is to augment critical care and reach people who may have trouble reaching a hospital (due to overcrowding, rural areas, pandemics, etc.) or may be negatively affected by inpatient care (those at severe risk of infection, people with complex chronic disease, etc.).
When it comes to building an acute care hospital-at-home program, choosing a team of competent professionals is essential. That’s where the community paramedic plays a key role.
The community paramedic is as versatile as a Swiss Army knife. For hospital-at-home programs, the well-trained and experienced community paramedic can be an invaluable asset.
Community paramedics typically come from the prehospital environment. This means they are comfortable entering a patient’s home and providing rapid, accurate evaluations. It also means they have interacted with a high volume of critically ill patients, many of whom are on the verge of death.
For this reason, community paramedics who have been specially trained in critical care are prime partners for hospital-at-home programs. Not only do these providers have a passion for out-of-hospital medicine, but they can also recognize serious illness and perform lifesaving procedures.
Here’s how hospital-at-home and community paramedics work together:
- Safety Assessment and Evaluation Committee
- Daily Evaluation by In-Person Providers
- Remote Access to a Physician via Telehealth
- Remote Access Wearables for Patient Monitoring
- Coordination with Primary Care
Okay, let’s have a closer look.
Safety Assessment and Evaluation Committee – Ensuring Only Appropriate Patients are Chosen
The first step in a hospital-at-home program is to properly select the patient. For those who are slightly skeptical of the system, we understand that the first reaction to a hospital-at-home program is a series of worst-case-scenario “What if?” questions.
To ensure that these “worst-case scenarios” don’t occur, a committee of physicians, nurses, and advanced practice providers will evaluate each potential patient and ensure that rigorous safety standards are applied.
Let’s look at an example. Consider someone who has recently had angioedema (severe facial/tongue swelling), and the physicians are monitoring to ensure the airway doesn’t close and require surgical intervention. A patient like this would not be a candidate for a hospital-at-home program. Even though community paramedics are trained in emergency airway management, the imminent need for surgical intervention would exclude home care.
Now, let’s have a look at another example.
Consider a person who has recently had trouble with COPD and has developed pneumonia. They may require antibiotics, fluids, and close monitoring. This patient would be more likely to be a candidate for care at home. Community paramedics are trained to perform all the tasks required for routine care of this patient, and if something should go wrong, there are protocols in place for rapid transport to the hospital.
We could list more examples, but the overarching point is this: Patients will be carefully selected by a committee to always ensure their safety.
Note: Even though we are making a big deal about safety, it would be an error to assume that hospital-at-home programs invariably provide “lesser care” or that they are somehow a tolerable downgrade in care. On the contrary, some studies have shown improved recovery times and better outcomes when patients are treated at home.
Daily Evaluation by In-Person Providers (Often Twice a Day or Continuous)
We discussed how important patient selection and safety are to hospital-at-home programs, but now let’s talk about some of the built-in tools that make these programs work. The first thing to know is that hospital-at-home programs do not just leave patients at their homes alone and hope for the best.
In many programs, a trained health provider may be with the patient constantly. If not constantly, the patient will be checked at least twice daily by a provider. In this way, unlike programs where a patient may receive weekly visits, the patient receives daily in-person visits to assess and manage their condition.
When a provider is not directly present, there are many modern ways to stay connected (which we will discuss in later sections).
How Does Telehealth Give Hospital-at-Home Patients Access to a Physician?
While there are some instances in which a physician may visit a patient at home, most hospital-at-home programs will use modern tools like video calls to facilitate a telehealth assessment.
Typically, a trained community paramedic or nurse will be on the scene with the patient. They will conduct the video call with the physician and serve as the physician’s eyes and ears during the assessment. When this method is used, physicians can still complete their daily “rounds”; however, instead of being in the patient’s environment, they are virtually present via telehealth.
This method gives the patient reassurance of an in-person provider while also providing the expertise of their physician. It also allows a physician to be more efficient in their care. Patients who can be safely and effectively managed via telehealth do not take as much time away from those who may still require an in-person evaluation (or procedure) from the doctor.
Remote Access Wearables for Patient Monitoring in Hospital-at-Home MIH-CP Collaborations
Video calls are not the only remote tool community paramedics use to facilitate a hospital-at-home program. These days, there are many modern “remote health monitoring tools” that can transmit data without a provider present. These tools are already used in the hospital.
When a patient is in their room, the nurse typically connects them to vital signs monitors (pulse oximeter, ECG, and blood pressure, at a minimum), and these vitals are displayed directly at the nurse’s station. If anything changes, the nurse sees it on their screen and knows to go directly to the patient’s room to check on them.
The same principle is used in hospital-at-home programs, though the transmission distance is a little longer. These devices are sometimes called “wearables,” and they are placed on the patient at home and then transmit their data to the healthcare team.
Just like in the hospital, when a patient is admitted to a hospital-at-home program, they will have someone assigned to monitor their vitals continuously. If something dangerous is detected, or the patient calls for help, a mobile provider, such as a community paramedic, can be sent directly to the patient’s home to assist them.
There are many different types of wearables, including those that monitor blood sugar, capnography, and heart activity. Using these tools allows out-of-hospital programs to provide the same level of care as when a patient is directly admitted to a hospital floor.
How Does Coordination With Primary Care Improve Hospital-at-Home Outcomes?
Another major benefit of using community providers in hospital-at-home programs is improved care coordination and reduced overall costs. Not only will there be more beds available at the hospital, but the patient can also receive care in the comfort of their home.
The community paramedic will coordinate with primary care providers, chronic disease specialists, and even pharmacists to ensure that no unnecessary duplication of care leads to added costs.
Aside from the costs, coordinated care leads to a better experience for the patient. Just think about a sports team. Does the team win when everyone works in isolation? No. The team only wins when everyone is in careful coordination with others. And that’s what community paramedicine brings to hospital-at-home programs.
Conclusion: The Untapped Value of Community Paramedicine in Hospital-At-Home Care
We will likely see more hospital-at-home programs pop up in different parts of the country in the years to come. Community paramedicine is a valuable resource to help augment the care provided by advanced providers and ensure that hospital-at-home initiatives are successful.
MIH-CP providers can help screen patients to ensure safety, provide a virtual connection between doctor and patient, and offer in-person evaluation to ensure the patient stays on track.
If you’re curious about software to help you manage your hospital-at-home program, contact Julota for more information. A representative would be happy to discuss your needs and provide a detailed demonstration of our services.
Related reading
- Wound Care at Home: How Community Paramedics Are Closing the Gap for Post-Surgical and Diabetic Patients
- Medication Reconciliation in MIH-CP Programs: Closing the Safety Gap Between 911, Home, and Primary Care
- Delivering Care with Community Paramedicine Where Patients Most Want to Be… Their Home
