ProMedica Acute Care at Home Patient Stories

Erik – COVID-19

Throughout the pandemic, ProMedica Acute Care at Home (PACH) has collaborated with hospital Infectious Disease specialists to effectively manage low-risk COVID-19 patients. These patients often require oxygen via nasal canula, IV steroids, respiratory medication, DVT prophylaxis, and Remdesivir infusions.   Many patients receive this treatment after transitioning home under the care of the Acute Care at Home team following intake in the emergency department or an admission to a hospital inpatient unit. In some situations, a patient may be directly admitted into the program without leaving their home.

Erik is one such patient. At 35 years old, Erik has the unofficial title of being one of the sickest COVID-19 survivors who was cared for at a ProMedica hospital. During his debilitating illness, Erik spent more than 240 days in hospital and LTAC units during which time he was critically ill and had to learn to walk and care for himself again.

Following Erik’s return home, he began to decompensate. Concerned that he was experiencing another COVID-19 infection, bacterial pneumonia or complications from his original infection, Dr. Jennifer Hanrahan, Medical Director of ProMedica’s Infectious Disease service, sought admission to PACH for Erik. The PACH team agreed that Erik could be treated effectively at home to prevent exposure to possible hospital-acquired conditions and mitigate any negative psychological responses that might be triggered by another inpatient hospital stay.

Within hours of being contacted, the PACH team set up technology in Erik’s home and in-home clinicians in collaboration with physician video visits assessed Erik’s condition and made plans for his treatment.

During his time as a patient of PACH, Erik received diagnostic imaging, lab draws, and needed medications including a Remdesivir infusion. The hospitalists and infectious disease physicians continued to monitor and video visit with Erik daily until he was successfully discharged from the program without ever stepping foot in the hospital.

Ariel – Cystic Fibrosis

Ariel is a 21-year-old patient with Cystic Fibrosis, which is an inherited disorder that causes severe damage to the lungs, digestive system, and other organs in the body. Due to her condition, Ariel experiences regular and frequent hospital admissions. The repeated admissions, which often last at least two weeks, often cause her to experience severe anxiety attacks and complicate her recovery.

ProMedica Acute Care at Home (PACH) has provided an acute hospital substitution for Ariel in recent months. During her PACH admission, Ariel received two weeks of antibiotics and aggressive pulmonary regimen. She also received daily visits from nurse practitioners, mobile integrated health paramedics, and home health nurses. Her care was managed via daily video visits by PACH hospitalists and Ariel’s normal pulmonary nurse practitioner.

Pulmonary specialist Leah Hughes APRN-CNP stated “During Ariel’s episode with Acute Care at Home, she was able to receive the needed medical treatment at home while also avoiding the psychological stressors associated with previous hospital admissions. It was very impactful to see Ariel’s mood stay upbeat which led to her staying very involved in her own care. It was great to see the difference the little things like putting on make-up and doing her hair made to Ariel’s recovery. It made me happy.”

While not all CF exacerbations are appropriate for an Acute Care at Home stay, when the patient is able to remain in their own home both medical and psychological outcomes can be successful.

Damien – Febrile Neutropenia

Damien is a 35-year-old male with a history of T-cell lymphoma. As a result of his chemotherapy regimen, Damien developed febrile neutropenia which normally requires hospitalization for symptom management, aggressive antibiotic regimens, and the close monitoring of bloodwork.

Recognizing patients experiencing febrile neutropenia may benefit from receiving hospital-level care in their own home, ProMedica Acute Care at Home (PACH) developed a Care for Oncology Patients program in 2021 in collaboration with ProMedica Cancer Institute. Based on the development of this additional clinical capability, Damien was admitted into PACH multiple times following his various rounds of chemotherapy.  As the hospital-at-home model repeatedly demonstrates, immunocompromised patients benefit from remaining in their home settings by protecting them from possible hospital acquired infections, improving patient mobility and participation, and relieving the psychological stressors of a prolonged hospital stay.

During Damien’s admissions, he received needed medical management from the PACH hospitalist, Infectious Disease specialists, and Hematology/Oncology specialists. In-home treatments and assessments were performed by Nurse Practitioners and Mobile Integrated Health paramedics and any needed medications or supplies were delivered directly to the home. Additionally, he was transported to and from the nearest ProMedica hospital to have physician-ordered CT imaging.

Ongoing involvement by specialists is an important capability PACH has built into their program design.  This allows patients to benefit from the expertise they need and expect while being able to stay in their home to receive hospital-level care and treatments.