Duke gives some COVID-19 patients a choice: a hospital bed or their bed at home
When Susan Sellars was diagnosed with COVID-19 pneumonia, she was sent to the emergency room at Duke University Hospital, where doctors told her she would be admitted to treat her labored breathing and severe cough.
Then they returned a short time later with an alternative: Sellars could go home, through an experimental home health program for COVID-19 patients. She’d be given the supplemental oxygen she needed, have her condition and vital signs checked regularly through a tablet and receive as many visits from a nurse as she needed each day.
Duke Health developed the program last month in response to the post-holiday surge in COVID-19 patients that made hospital beds scarce across North Carolina. The main goal, said Cooper Linton, the associate vice president of the group that put it together, was to relieve some of the pressure on the three hospitals in the Duke Health network.
“The main benefit for the hospital is ensuring that everybody in the community has access to the necessary beds,” Linton said. “In an unprecedented time like we’re dealing with in the pandemic, COVID beds in the hospital are an incredibly scarce resource, and we want to maximize their use.”
But the healing-at-home approach also has plenty of benefits to patients who qualify, like Sellars, 43, who lives in southern Granville County. She’s had three kidney transplants since she was a child, which has left her with a depressed immune system as well as hard-won familiarity with hospitals and medicine. She’s been a Duke patient for 30 years.
“I don’t like being in the hospital, and overall I feel more comfortable at home,” Sellars said. “I think I heal better at home. My husband can take care of me. And I’m around my pets,” her three dogs and a fourth the couple is fostering.
Duke still learning from a new approach
Duke’s Enhanced Home Health COVID Care program is still new, and Linton and others say they’re still learning what works best. Sellars was the first patient to enroll, on Jan. 14. So far, just a half dozen patients who otherwise would have been admitted to the hospital have taken part.
That’s because the approach doesn’t work for everyone. Before considering someone a candidate, Duke will first ensure that the patient has a safe environment to go home to, within 20 minutes of an emergency room, and that there’s a family member or other person to care for them, said Rachel Dye, one of the home health nurses caring for the patients.
“If they don’t have a primary care provider in the home, someone who can be there 24/7 to look after them and to be able to notify us if there are any complications or if they have any trouble, they would not be appropriate,” Dye said.
Realistically, that caregiver will be someone who has also tested positive for COVID-19 but hasn’t gotten sick. In Sellars’ case, that was her husband, who was infected with the coronavirus but only developed a cough.
Dye said patients must be motivated and able to take on more of their care themselves. That includes taking their medications as directed, regularly using a pulse oximeter to measure their heart rate and blood oxygen levels, and breathing into an incentive spirometer, a simple plastic device that helps them breathe more deeply.
The patient must also be willing and able to periodically lie on their stomachs, a process called proning or “adult tummy time” that helps many patients absorb more oxygen when they breathe.
“Patients will wear the pulse oximeter and report, ‘Hey, my oxygen went up to 100% while I laid on my stomach today,’” Dye said.
Patients benefit from being at home
But in return, patients avoid the isolation of the hospital, where visitors are strictly limited and most COVID-19 patients see only doctors, nurses and other health care workers covered in masks and shields. They’re also more in control of their environment and their schedules, as opposed to the hospital where nurses, therapists and others come and go at all hours, Dye said.
“You don’t really get a lot of down time, and so you don’t really get good sleep,” she said.
Plus, the food is better, Sellars said.
“I was able to get good meals,” she said. “You know, food at the hospital’s not the best.”
Sellars was only in the program for about a day and a half, before her doctors agreed she was well enough to “discharge.” Duke came to retrieve the machine that concentrated oxygen for her to breathe and the other equipment but still periodically called to check on her.
Duke says it expects patients to remain in the program two to five days, when they might transition to more traditional, less-intensive home health care. But two patients enrolled so far eventually had to be admitted to the hospital anyway, because of concerns about the amount of oxygen they were getting at home.
“If we see even a hint of decline, we bring them back to the hospital,” Dye said.
Linton said patients enrolled through the program are billed through Duke’s home health program, rather than the hospital, and that Duke accepts what a patient’s insurance will pay, with no surprise charges.
“We’re providing an Angus Barn level of care. We’re not going to get an Angus Barn check,” he said. “But that’s OK. This is not about managing finances. This is about managing finite bed space and ensuring access to excellent care.”
This story was originally published February 3, 2021 at 6:30 AM.
