“This is the house call on steroids.” That was the concept of a virtual heart care program that launched during the COVID-19 pandemic, according to Sanjeev Gulati, MD, Chief of Adult Cardiology and Medical Director of Advanced Heart Failure at Atrium Health Sanger Heart & Vascular Institute. Sanger at Home, a pilot program that ran from December to March, enabled heart patients to receive care at home, receiving daily support and visits from providers. The program, which proved to be both effective and convenient for patients and providers, now serves as a model for virtual cardiac care. The positive feedback we received from patients and providers about this program is guiding us into a new, exciting chapter.
The pilot program helped large patient populations at Sanger, including many atrial fibrillation and heart failure patients. Sanger at Home connected these patients to the specialized cardiac care teams at Sanger, even from the comfort of their homes.
When patients enrolled in the pilot program, care teams provided them with a scale, blood pressure cuff and pulse oximeter. Patients tracked their own vitals and partnered with Sanger care teams to manage their care. In addition, Atrium Health community paramedics visited patients’ homes daily to perform laboratory testing, help with medication management and assist patients with virtual appointments with their care providers. When patients needed advanced medical therapies such as an electrocardiogram (EKG), paramedics also had the tools required to help with advanced medical therapies from the comfort of patients’ homes.
As we move beyond the COVID-19 pandemic, Sanger’s pilot program is becoming part of Atrium Health Hospital at Home (AH-HaH). We spoke with Dr. Gulati, who shares what teams learned from the pilot program, and how they’re implementing key learnings to continue to care for heart patients enrolled in AH-HaH.
Question 1: How did care teams partner with patients during the pilot program?
Answer 1 | Dr. Gulati: Sanger at Home allowed us to safely take care of patients who have certain diagnoses who don't need to be in the hospital for an extended period of time. There are a significant number of patients who are stable and who don’t need to be in the hospital, but they still need more intensive care than a regular office visit. Sanger at Home gave these patients a wrap-around package. We have caregivers who visited each patient’s home daily, who could perform exams and do things like give IV medications. On top of that, Sanger’s advanced practice nurses (APNs) and advanced practice providers (APPs) called the patient each day to check on them and to answer any questions they may have. Also, the program gave each patient equipment that they can use to monitor their health from home, including a blood pressure cuff, scale and pulse oximeter that can transmit results electronically to the hospital.
Ten years ago, people would come to the hospital for issues that they no longer need to come to the hospital for. My philosophy is that our hospitals need to take care of complex, critically ill patients, while other patients who do not need to be in the hospital should be taken care of it in a non-hospital environment, as long as it's a safe environment.
Q2: How does virtual care benefit the patient?
A2 | Dr. Gulati: Our patients stay in their own environment, so there's an emotional component that comes with remaining in your comfort zone. Also, family support is much richer at home, versus having relatives come to the hospital during visiting hours.
This virtual care option gives comfort to the caregiver, too. It’s stressful to have a family member in the hospital. Caregivers have to balance their jobs and responsibilities with visits to the hospital, maybe even sleeping in a chair to stay with their family member. So there are benefits to both the patient and the caregiver from an emotional and a support standpoint, and I cannot overstate the value of that.
Q3: How can these advantages improve patient outcomes?
A3 | Dr. Gulati: When we talk about outcomes – particularly with atrial fibrillation and heart failure – the social determinants of medicine and the emotional determinants of health care directly impact patient well-being. We know that depression and anxiety are common among patients dealing with chronic illnesses and being in an environment that feels safe and comfortable with emotional support from family nearby will definitely lead to better outcomes.
Q4: During the COVID-19 pandemic, how did Sanger at Home benefit other patients?
A4 | Dr. Gulati: From a community standpoint, Sanger at Home helped us accomplish two things. One, it has been able to reduce the cost of taking care of patients, so we can take care of more people in our community. And two, it allowed us to get beyond the limitations of our bed availability. During the COVID-19 pandemic, bed availability has become an issue around the country, but it can also be an issue during normal flu season, too. From this standpoint, it’s valuable to be able to care for more patients outside the hospital. It’s not only good for the patients, but it’s good for society in terms of reducing the spread of this virus and others. It’s good for our hospital providers because it allows us to minimize their exposure risk and care for more people. Sanger at Home saved 175 bed days at the hospital during the pandemic surge in early 2021, which was a big accomplishment at a crucial time, and it shows the potential of this model.
Q5: What feedback have you received from patients?
A5 | Dr. Gulati: We've heard very positive feedback from patients about getting a high level of care. They tell us that they feel comfortable with the community paramedicine teams, the APPs and the APNs who are taking care of them. Patients in general don't want to be in the hospital for a variety of reasons, especially during a pandemic, so they’ve been appreciative to receive care at home.
Q6: How will Sanger at Home integrate into Atrium Health Hospital at Home?
A6 | Dr. Gulati: As we move beyond the surge of COVID-19, Sanger at Home has become part of Atrium Health Hospital at Home (AH-HaH). AH-HaH is admitting these heart failure and atrial fibrillation patients and managing them at home with the same combination of services. The Sanger team provides consultative services to the AH-HaH team for the patients who require cardiology care. The services are now seamlessly integrated for the patient to make this a convenient and effective way to receive expert heart care at home.
To learn more about virtual heart care with Atrium Health Sanger Heart & Vascular Institute, please call 704-512-5712.
