Newman's Notions | November 2021 | FREE
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Home is where the hospital is

Learn how the hospital and the home are the same but different.

The concept of caring for an acutely ill patient at home is not unique to the current era. Quite the opposite. From Ancient Rome through the Middle Ages, hospitals served a special and limited purpose. However, since the beginning of the 20th century, led by advances in imaging, surgery, and revenue generation, hospitals became the primary place to receive acute care. Now, as a new technology, telemedicine, combines with hospital crowding plus fears of contagion, the hospital-at-home movement is entering a growth boom.

Illustration by David Rosenman
Illustration by David Rosenman

Acute care, or hospital, at home is increasingly seen as a patient-centered, census-reducing alternative to hospitalization in a “brick and mortar” facility. It has posed challenges and opportunities in everything from pharmaceutical delivery to physical therapy, telecommunications to record keeping. However, after countless hours of cogitation, we have identified some reasons why the hospital and the home are the same, but different.

The room: In the hospital, everyone wants a private room. Nobody wants to share a bathroom or a television. And nobody wants to listen, or smell, as their roommate snores, belches, flatulates, or other things too fierce to mention. No such guarantee at the hospital at home, especially for our married patients!

Admissions: A combination of Uber and Google maps will get you from the ED to your hospital-at-home room much faster than the typical wait for transport to the ward. And you will earn rewards points!

Discharge: For patients at home, the only acceptable alternatives to “discharge to home” are “discharge to man cave,” “discharge to back porch,” and “discharge to jacuzzi.”

HIPAA: To be safe and meet all relevant regulations, you must remove your name from your mailbox. This may make receiving packages from the pharmacy difficult and impair life-saving equipment deliveries, but rest assured that if you survive, you'll be fully compliant.

Joint Commission: Nothing strikes fear in the heart of the administrator like the announcement that the Commish is in the house. For the hospital at home, the JC has subcontracted with your neighbor. There's a reason she keeps dropping in and asking what you would do if the house caught fire. Remember RACE: Running And Cat Evacuation.

Supplies: That certain company with the signature arrow logo is in negotiations with CMS to be the prime delivery mechanism for your meds. But if you want that antibiotic delivered in a timely manner, best to use your membership account. The same applies to lab test results; know your hemoglobin in five days, or two days if your premier membership dues are paid.

Infection risk: Hospital-acquired conditions are a real issue, but apartment-acquired infections are no laughing matter, unless you find them to be funny. The number-one source is the refrigerator, followed by your pet. We told you an iguana was a bad choice, and now you have salmonella. Or maybe your cat gave you toxoplasmosis. Your parrot gave you psittacosis, your bunny tularemia. Your dog only gave you love (but he tore up your couch).

Readmissions: Readmission is pretty much guaranteed in this model, but remember your key. There's an extra under the mat just in case.

Nutrition: Bloody Marys do not count as a serving of vegetables. With an olive, though, you can count it as a fruit serving.

Environmental services: In the hospital we may use an ultraviolet disinfection robot. They are handy and efficient. No such luck in your house. You may purchase your own Roomba and duct tape a black light to it. Please note that it won't change your sheets or do windows (yet).

Work hours: Your family and friends are not subject to work-hour restrictions. Convenient, no?

Length of stay: Nobody is monitoring your LOS too closely, but pay your rent, or your days covered will terminate at the end of the month.

Surgery: In the future, surgery at home is only to be expected. Similar to how physicians out on the prairie in the early 20th century would remove an appendix on the kitchen table, it is only a matter of time until you have your triple bypass in your apartment. Make sure you have a sturdy kitchen table and plenty of paper towels.