The nausea coursed through her body, an unwelcome companion during her cancer fight. This time it was bad, worse than normal. She needed help. But, instead of heading to the emergency department, she picked up the phone. Her oncology team coordinated with specially trained and outfitted nurses ready to react within moments-and a nurse from this Penn Medicine Cavalry team was dispatched to her home with intravenous medicines. Two hours later, the last waves of nausea dissipated, and her appetite returned. The fight continued, and she never had to leave her house.
Scenarios like this one are increasingly common, as Penn Medicine is reimagining many aspects of health care so that patients can more easily get the right care at the right time and place. This often means helping them safely avoid a trip to the emergency department, or to get the advanced treatments they need outside of a hospital setting. The ultimate goal, especially for patients with chronic and serious diseases, is to make it easier for people to build health care around their lives rather than building their lives around care. And the effort goes hand in glove with preventing chronic illnesses in the first place across the communities that Penn Medicine serves.
It's a mission growing both in urgency and possibility. The population is aging, and more people are dealing with chronic conditions. Meanwhile, many smaller hospitals are closing under financial pressures, further driving demand for those that remain, especially in their emergency departments. And demand for inpatient hospital beds is consistently high.
"The journey we're now on is, how do we now move acute care outside of the hospital?" said Penn Medicine Vice President and Chief Transformation Officer Raina Merchant, MD, MSHP. "How do we totally change the paradigm?"
Home is where the patient is (or wants to be)
The paradigm shift is built on the bedrock of home care that has already long been part of the Penn Medicine portfolio. The capabilities of Penn Medicine at Home were both tested and supercharged by the pandemic. Remote care and telehealth became vital connectors that opened the door to moving more care into the home.
"At this point, it's about taking all of the lessons learned from care that we've been delivering at home for years, and building on that, making it sustainable so that it becomes part of the way that we operate as a system," Merchant said.
Nurses and doctors can remotely monitor a patient's vital signs and maintain constant contact via tablet computers given to patients. Other technological advances have made it safer to deliver a wider range of chemotherapies and other infusions at home. Homes around the region have been connected into virtual hospital floors, centering care around patients on their terms.
Penn Medicine at Home is rare among home health care organizations in that it provides a wide variety of services to patients while thoroughly integrated as part of one system of care with inpatient, outpatient, and virtual care, through a single electronic health record. Its offerings have included palliative care, hospice, infusion therapy, and physical therapy.
