Hospital at Home relies on the ability to bring diagnostic and therapeutic care technologies and providers into the home setting. While the physician visits daily, the RN serves as the coordinator of care, patient education, and ancillary services.  Initially, the RN observed the patient in the home for the first 24 hours, but that level of care was unnecessary for some patients and is now adjusted based on individual patient need.

Diagnostic tests that are performed in the home include x-rays, echocardiograms, and electrocardiograms.  In addition, the team can administer intravenous fluid drips, medications, and oxygen therapy in the home.  The team follows the patient’s care until s/he is deemed ready for discharge, at which time the patient is “discharged” from the Hospital at Home to her/his primary care physician.

The Hospital at Home field RNs play the role of coordinating the care for each patient in the program.  While the care plan is physician-driven, the RN coordinates the care map for medical care including documentation and discharge criteria.  Nurses are responsible for ordering supplies and coordinating all diagnostic and therapeutic care provided in the home.  For example, when a physician orders a medication, the RN calls the pharmacy to arrange for home delivery and then checks in with the patient to ensure that the medication was delivered.

During the first home visit, the nurse completes both a patient assessment and a patient “living space’ assessment.  The RN will review a patient’s medications and reconcile them.

The Hospital at Home model institutionalizes a strong back-up and on-call support system for its nurses and physicians.  At the Portland VA Medical Center, the Program at Home devoted resources for a 24-hour on call nurse, which really allowed them to provide successful care in the home and prevent fewer hospital admissions from the home.  In addition, a physician medical director is on-call every other weekend to provide support and oversight.