Nursing Success within Hospital at Home
In light of ongoing staffing challenges, Hospital at Home programs offer new opportunities for nurses, enabling meaningful interactions with patients and high-quality care delivery and supporting high-acuity care in the home, while breathing new life into their careers. But defining the roles, recruiting, and training for these brand new, tech-enabled programs can be a challenge for program leaders.
Sarah Joyce, Chief Customer Officer at Current Health interviewed Deidre Rolli, BS, RN, Clinical Care Coordinator for the Hospital at Home program at UMass Memorial Health, and Brett Young, MSN, RN, the manager of Hospital at Home at Vanderbilt University Medical Center. Rolli and Young have a front-row seat to how this care model is benefiting patients and providers in their successful Hospital at Home teams.
Hospital at Home offers a new way forward for exhausted bedside nurses
The field nurses in the Hospital at Home care model have two one-hour visits daily, where they can foster a personal connection with the patient with their family. During this uninterrupted time, they can see what’s going on in their surroundings that primary care and facility providers aren’t aware of. They identify health inequities like food insecurity, and other problems that can trigger readmissions.
“We’re able to address a lot of the issues, get them community resources, make sure they have enough resources to get their medications funded for them, or rides to appointments for those who need transportation. And the nurses are excited to be in teaching mode, and being patient advocates, and getting back in touch with the human part of a patient, where it’s not an emergency or someone in the highest stress environment that they’re dealing with. Now they actually get to have a one-on-one relationship and the job satisfaction has been great for our nurses,” shared Rolli.
Experienced nurses thrive in Hospital at Home
Recruiting nurses is a challenge with no end in sight. But both leaders are finding it to be easier to recruit nurses for Hospital at Home than for traditional bedside roles.
Vanderbilt relies upon a Nurse Residency program recruits graduates for Hospital at Home. They require two years of experience in an inpatient setting, which makes their market very competitive.
“Most of our employees have over 15 or 20 years of hospital experience, but they’ve also worked in case management, home hospice, or clinics, and they’re searching for something new. They have some history of working in the hospital, and that tends to be a more mature workforce,” explained Young. He also suggests aligning with internal home care teams on recruitment strategies.
When evaluating nurses for their teams, Rolli and Young look for critical thinkers.
“We like at least five years of experience when you’re coming into the home, because there is so much independent thinking. Fortunately, a lot of staff that have come to our program have come by word of mouth because of the success we’ve had—it’s friends recruiting friends. We look for nurses that can think on their feet, act quickly if there’s an emergency in the house, and also act like the MacGyver, because it’s hard to carry all that equipment in the house and there are days where you’re climbing up on somebody’s couch to hang an IV pole. It’s about thinking out of the box, and we found that the success was easy and has really brought our program to where it is right now,” said Rolli.
“The big thing is resource availability and critical thinking skills to operate independently, because you won’t have somebody down the hallway to jump in and help you. We don’t have a charge nurse running point. We have one RN in the field, one in the command center, and one in the hospital, so we need someone to be highly proficient,” said Young.
The importance of onboarding and ongoing training
The overall newness of Hospital at Home programs means onboarding, training, and ongoing support for nurses are requirements for success.
UMass has developed an orientation process to get recruits up to speed. Part of that process involves having nurses shadow more tenured nurses for a month to make sure they’re familiar with all the new equipment and technology.
“When you’re starting a program, everybody’s going in blind. You take it day by day. Some nurses with 10, 15, or 20 years of experience may not be familiar with the latest technology. We encourage staff to stay aware of trends and incorporate continuous learning opportunities about Hospital at Home programs so everyone is up-to-date with the innovation happening in other programs,” said Rolli.
The Vanderbilt program also requires some shadowing, as well as training in the hospital.
“When we started, we had a lot of home health ride-alongs. But now that we’re open and we have patients, you can get your ride-along time with our existing team members. We also train nurses in the acute hospital so they can have a more holistic understanding of the patient flow and referral pathway. Because we don’t want to operate in a silo,” said Young.
Digital health technology and virtual support are a must
Most Hospital at Home programs find they can’t operate without a reliable remote care platform and some degree of outsourced support.
“We have a monitoring team that watches our patients’ vital signs 24 hours a day, and that’s an important piece of the Hospital at Home program. You need somebody to watch these vital signs 24 hours a day, just like a patient was in the hospital, and we’re allowed to do that with our partnership with Current Health,” said Rolli.
Young stressed the importance of reliable connectivity with whatever vendor you’re using, contingency plans in case of downtime, and quality and safety measures for the patient.
When it comes to patient outcomes, the UMass program has a readmission rate 6% less than the readmission rate for original discharge from the hospital. And for dual-eligible patients, their readmission rate is just 2.3%.
When asked how their team has achieved such impressive metrics, Rolli offered: “Our follow-up is key. We personally call and make follow-up appointments to ensure our patients get appointments with their doctors in a timely manner. There’s such a race to discharge patients from the hospital. We don’t leave anything up to the patient before they’re discharged. We tie up everything with a bow at the end of your package once you’re discharged from the Hospital at Home program.”
A few metrics that Vanderbilt’s team is proud of include their patient satisfaction survey results and nursing sensitive quality metrics, which match their highest performing medicine unit.
Young points to their program’s integration with the health system’s other services to keep patients happy and prevent readmissions: “We have some post-acute care integration with our discharge care center that we’re very pleased with having either text message or phone call follow-ups, and we can initiate field visits post-acute care, with our home health colleagues. We’re very pleased so far.”