Virtual hospital expands inpatient capacity during coronavirus pandemic

By Christopher Cheney, HealthLeaders Media

Health systems can expand their inpatient capacity during the coronavirus pandemic and beyond with a virtual hospital at home program, a recent study shows.

As the coronavirus pandemic rages nationwide during its third surge this year, resources are being strained at health systems and hospitals across the country. Virtual hospital at home programs have emerged as a viable option to ease inpatient bed capacity limitations at hospitals.

Charlotte, North Carolina-based Atrium Health features 50 hospitals and other healthcare facilities in three states. The health system launched a virtual hospital at home program for COVID-19 patients in March and recently published a study about the initiative in Annals of Internal Medicine.

Atrium Health’s virtual hospital at home program is split into two separately staffed “floors.”

“The ‘first floor,’ or virtual observation unit (VOU), is designed for low-acuity patients who can be managed remotely with daily telemedicine-supported symptom monitoring by RNs. The ‘second floor,’ or virtual acute care unit (VACU), is designed for patients who would otherwise have been admitted to a traditional brick-and-mortar hospital providing inpatient care, such as oxygen, medical treatments, daily virtual physician rounds, vital sign monitoring, twice-daily nursing assessments, and daily paramedic visits,” the study’s co-authors wrote.

The study includes several key data points about Atrium Health’s hospital at home VOU and VACU:

• From March 23 to May 7, 1,477 patients received care through the VOU or the VACU, or both settings
• 1,293 (88%) patients were admitted to the VOU
• 40 (3%) of the VOU patients were admitted as inpatients at a conventional hospital
• 184 (12%) patients were admitted to the VACU
• 22% of the VACU patients required respiratory inhaler or nebulizer treatments, 22% of the patients required supplemental oxygen, 9% of the patients received antibiotics
• 24 (13%) of the VACU patients were admitted as inpatients at a conventional hospital
• Of the 24 VACU patients admitted at a conventional hospital, 10 (42%) required ICU care, 1 (3%) required mechanical ventilation, and none died during conventional hospitalization

Crucial elements of virtual hospital at home program for COVID-19 patients

The lead author of the Annals of Internal Medicine study recently shared the keys to success of Atrium Health’s virtual hospital at home program with HealthLeaders. “Any health system considering developing a virtual hospital program for COVID-19 patients should have an interdisciplinary approach to succeed,” said Kranthi Sitammagari, MD, co-medical director for quality at Atrium Health.

There are six primary considerations for this kind of program, he said.

1. Develop an interoperable electronic health record for easy navigation between traditional hospitalization and the virtual hospital
2. Develop a virtual care platform for clinician visits
3. Develop a team of mobile caregivers—paramedics and/or registered nurses—to conduct in-home visits
4. Develop a strong supply chain for home monitoring equipment, including thermometers, blood pressure cuffs, and pulse oximeters
5. Develop evidence-based eligibility criteria, monitoring protocols, and treatment protocols
6. Analyze the costs of the program and allocate the budget accordingly

Atrium Health had a foundational infrastructure that helped the health system build a hub-and-spoke virtual hospital model, Sitammagari said.

“At Atrium Health, there was an established transitional services program that had been serving patients discharged from the hospital who were at high risk for readmission, utilizing community paramedics for in-home visits. Also, a robust telemedicine program utilizing a virtual care platform was available to deliver care for virtual in-home visits. A dedicated group of virtual hospital medicine providers and nurses were available to provide 24/7 coverage and monitoring along with other specialties linked as needed for virtual consultations.”

Benefits of virtual hospital at home program for COVID-19 patients

Having a virtual hospital at home program for coronavirus patients generates four primary benefits, Sitammagari said.

1. A virtual hospital at home program for COVID-19 patients can limit traditional hospital admissions and increase the bed capacity of traditional hospitals to care for severely ill patients who otherwise cannot be managed outside the hospital setting.
2. Mildly to moderately ill patients can be kept outside traditional hospital settings, which limits the virus exposure of healthcare staff and other patients.
3. A virtual hospital at home program decreases demand for personal protective equipment, which has been in short supply throughout the coronavirus pandemic.
4. A virtual hospital at home program boosts patient satisfaction because they are happier to stay at home with loved ones rather than being isolated in a traditional hospital.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.