From hospital to home with just a mobile phone


The Safer at Home programme provides a pre-programmed mobile phone that allows patients to communicate with a medical team via audio or video call, so that they can be monitored and managed at home, rather than be admitted to the hospital. — TNS

After dealing with a persistent cough and diarrhoea, and cycling through various over-the-counter medications, Javier Muniz finally went to urgent care at the Los Angeles County-USC Medical Center last month (April 2023).

Physicians at the hospital in the United States, which has since been renamed the Los Angeles General Medical Center, realised that Muniz’s medical history included living with HIV (human immunodeficiency virus).

The 46-year-old was diagnosed with giardiasis, an intestinal infection, and was hospitalised for four days while doctors treated his symptoms, drew blood and performed a CT (computed tomography) scan.

Hospital officials asked Muniz if he wanted to be one of the first people to participate in L.A. General’s newly-expanded Safer at Home programme.

This programme was launched during the pandemic to treat about 4,500 Covid-19 patients at home.

In September (2022), the programme began including patients with other medical conditions.

As of May (2023), at least 556 patients with 37 different diagnoses have participated in the programme.

They’ve been cared for remotely by a team of several dozen nurses and five physicians, according to hospital officials.

L.A. General is one of the largest public hospitals in the US and has historically treated medically-underserved patients in the region.

“What this is, is concierge-level medicine, which is what rich people are accustomed to getting, but instead, we’re giving it to the patients coming to L.A. General, both because it’s safer for the patients to not have to be in the hospital and it’s a much more patient-centred experience,” said the hospital’s chief medical officer Dr Brad Spellberg.

Slightly more than half of the patients were referred from the emergency department and avoided admission altogether; a little fewer than half were hospitalised, but discharged much earlier, according to him.

On average, the programme has saved about three hospital days per patient, compared with the typical stay of around five days.

Muniz was sent home with a pre-programmed mobile phone that allowed him to communicate with his medical team via audio or video call, as well as equipment, including a thermometer and pulse oximeter.

Nurses called him several times a day to track his progress, to make sure he was taking his medication properly and on time, and to answer any questions that Muniz had.

“When I’m hospitalised, I get stressed out,” he said. “It makes me just want to leave.

“It’s scary trying to figure out what’s wrong with oneself and waiting in a room isolated. It’s just not comfortable.

“Being hospitalised, you’re also away from family and friends, and the restrictions on visits make it hard to stay connected to your loved ones.”

The programme primarily serves patients with 10 different diagnoses, including skin and bone infections, kidney infections, bacterial and viral pneumonia, asthma, and congestive heart failure.

But hospital officials have developed a checklist with guiding principles that allows the programme to be expanded to other diagnoses, according to the programme’s medical director Dr Christopher Lynch.

The team is looking to expand to 20 diagnoses in the future.

The programme is covered by the hospital at no cost to the patient.

The programme also arranges transportation if needed for patients to their homes or to temporary housing, such as the hospital’s Restorative Care Village, which shelters housing-insecure people who may need a place to recover after receiving medical care, according to L.A. General’s Transitions of Care department associate medical director Dr Josh Banerjee.

The goal of the programme is to send every patient home with a pre-programmed mobile phone so that they’re able to easily communicate with medical professionals and have their wounds and other injuries examined via video call.

When asked about negative outcomes with the programme, hospital officials said that there hadn’t been any.

They said those enrolled in Safer at Home have had a hospital readmission rate that is “significantly lower” than the rate for all other discharges from the hospital.

To qualify for the programme, patients need to have stable vital signs and be clinically improving.

They also need to be able to tolerate taking medications by mouth and can’t have a condition that can only be treated at the hospital.

Muniz said that, as of Tuesday, he was feeling a lot better and would opt for the programme again in the future.

“They’re consistently taking care of me,” he said.

And he added: “I’m in the comfort of my own home.” – By Summer Lin/Los Angeles Times/Tribune News Service

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