Pandemic changes care for Duke Health emergency room patients

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RALEIGH, N.C.(WNCN) – Linda Bustillos is a caregiver for her 83-year-old mother, Marilyn Moore. Several weeks ago, her mother landed back in the ER with pneumonia for the second time.

“We were really down-hearted. We thought this was going to be quite a long haul,” said Bustillos.

Instead of being admitted into the hospital, she was offered the opportunity to recover at home. Something Bustillos said ended up in more sleep and rest for her mother than she would have gotten at the hospital.

“It’s really, really difficult to get any rest [in the hospital], and I think she was able to rest and then just having the comfort of being in her house. But also silly things like knowing the TV channel,” said Bustillos.

It’s part of Duke’s Hospital at Home program. The goal is to keep hospital beds free for the sickest patients. People who come to the emergency room at Duke Hospital may be able to use the program to recover at home rather than spending a few days in the hospital.

Requirement for program:

  • Live 10 miles of Duke Raleigh Hospital
  • Be insured by Medicare or Aetna Medicare Advantage AND eligible for inpatient care
  • Have one of the following conditions: worsening asthma, skin infection (cellulitis), congestive heart failure, worsening chronic obstructive pulmonary disease

“Maybe they had a urinary tract infection and they tried antibiotics with their primary care doctor but they need something through an IV or a little bit stronger,” said Dr. Vidhya Aroumougame, the Clinical Lead of the program

Up until now, a similar program was only available for those recovering from COVID-19. Under that program, patients need to meet strict oxygen level requirements and must have enough electric power in their home to supply power to medical devices patients take home. They also need to have someone living with them to be a second pair eyes for medical staff.

Aroumougame said careful consideration is given when enrolling patients into the program.

“We also go through and do a thorough review of their case and their condition to make sure this is safe for them,” she said.

Patients are expected to remotely monitor their own vitals. Hospital staff are alerted to any changes that need immediate attention. There are daily in-home visits from a physician and a nurse visits at least twice a day to provide in-person care. A hospital meal is even provided if the patients wishes.

“For me as a physician, [it’s] a great way to just add to the physician-patient relationship and see a patient in their home,” said Aroumougame.

It may even aid in the recovery speed for some.

“From a psychological perspective, it really helps somebody get better too when they have a lot of familiarity in their routine,” said Bustillos.

Duke expects to continue to this even after the pandemic.

“No hospital experience is great, anytime you have to have your loved one in the hospital but this made it as best as it could be,” said Bustillos.

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