Home monitoring reduces readmissions

Date: September 16, 2011

Safeguarding against medical errors and ensuring quality, efficient care is challenging enough when patients are in a hospital and constantly monitored by medical staff and technology. But when patients go home to continue their care, it’s quite a different matter.

To better observe patients with congestive heart failure and chronic obstructive pulmonary disease, and to avoid unnecessary hospital readmissions, Johns Hopkins Home Health Services started a program of remote patient monitoring that allows providers to react more quickly to changes in their condition.

Since the start of the program a little less than a year ago, the readmission rate for these two sets of patients hit 17 percent in March and 9 percent in April, compared with Home Health Services’ overall rate of 21 percent. The majority of those who were readmitted experienced a health crisis, such as pneumonia, that was unrelated to their primary diagnosis, according to Home Care Group nurse Lou Ann Rau. (Home Health Services is a company within Johns Hopkins Home Care Group.)

The program has served roughly 250 patients since it began. Patients receive instruction in how to use the devices, if appropriate, to monitor their blood pressure, weight, blood oxygenation and glucose levels, as well as peak air flow. The daily process takes about five minutes. After the information is recorded, a disease management nurse reviews it, and special alerts are automatically sent to the nurse if any new information falls outside of acceptable parameters. When necessary, the nurse will contact physicians to adjust patients’ medications and treatments or to schedule same-day office appointments. Such prompt attention can prevent return hospital visits that are costly and often less safe for patients than being treated at home.

“If the nurse sees that a heart failure patient is starting to gain weight and is a little more short of breath than usual,” Rau explains, “she may call the doctor and get an order for the patient to take an extra water pill for a day or two” to reduce swelling and fluid retention.

She says the system helps patients become better at recognizing signs that their condition is deteriorating and also makes them feel safer “because they have a nurse watching over them.”

The monitoring system enhances other Home Health Services safety interventions, such as visiting patients often during their first days back home to make sure that they understand their hospital discharge instructions and are following them correctly.