By Merin C. MacDonald
Like many hospitals, UMass Memorial Medical Center is in the midst of an ongoing capacity crisis which has been particularly burdensome in the intensive care unit (ICU). While the UMass Memorial Health (UMMH) Hospital at Home (HAH) Program, started in August 2021, has periodically cared for patients coming from the ICU, their teams see the potential for greater collaboration.
After a series of meetings with their colleagues in Critical Care, HAH and the ICU launched a closer partnership in January. Planning focused on building a successful collaboration through a series of concerted efforts including developing tools and technology, establishing relationships with the teams in the ICU, and education. “Until January, [Hospital at Home] simply wasn’t at the top of [the ICU team’s] mind because they’re really busy caring for patients,” said Constantinos (Taki) Michaelidis, MD, MBA, MS, medical director for the UMMH HAH Program, and assistant professor of medicine in the Division of Hospital Medicine. “Our work in January was really about building tools and human relationships. We had our nurses go to the ICU, introduce themselves, and help educate them about the types of patients that we care for.” If the ICU has patients who are floor-appropriate but there is no floor bed available and the patient passes the full hospital safety screening, the ICU can transfer the patient directly to HAH.
They are already seeing strong outcomes and collaboration with the Critical Care team including Nicholas Smyrnios, MD, Eric Cucchi, MS, PA-C, Sarah Skinner, MSN, ACNP, Molly Ward, RN, Shiv Sutaria, MD, Casey Phillips, RN, Candy Szymanski, MSN, RN, AVP, and many others using a new EPIC-based tool to identify appropriate patients at the time when patients are ready for transfer out of the ICU. In January, HAH took six referrals and admitted four patients, all of whom did very well. “It is still early but we'll continue to work together to build this relationship,” said Dr. Michaelidis.
One of the advantages of the HAH model of care is that it provides flexible solutions to issues like capacity challenges. “We should be pushing the boundaries of what is possible with Hospital at Home because it's much more flexible,” said Dr. Michaelidis. “You can build 20 home hospital beds in six to 18 months, whereas it might take a decade of planning and multi-millions of dollars to build new brick-and-mortar hospital beds.” He added that with brick-and-mortar, capacity challenges may get better for the short term but after a few years, the hospital beds fill up again.
While he is pleased with the initial outcomes of the new partnership with Critical Care and other HAH initiatives, Dr. Michaelidis cautions that this may all go away at the end of December 2024. “We will not be able to care for patients in Hospital at Home unless Congress acts before then to extend the CMS waiver that allows us to provide this care,” he said. “Everyone (including me) should be calling our congressman and our senators, to advocate for access to this type of care.”