Nurses Deliver Hospital Care in the Comfort of Patients’ Own Homes

An innovative Cleveland Clinic program delivers high-quality, comprehensive acute hospital care with a twist: neither patients nor their providers are physically in the hospital. Launched in 2023, Hospital Care at Home offers qualifying patients the option of receiving virtual, at-home treatment delivered by nurses in Cleveland Clinic’s Integrated Virtual Care (CIViC) Center in Vero Beach, Florida.

“Acute care can now be delivered in two distinctly different settings: a traditional brick-and-mortar hospital or in patients’ homes,” says Linda Walton, DNP, RN, CENP, Chief Nursing Officer at Cleveland Clinic Indian River Hospital in Vero Beach. “Either way, patients have access to the same expert clinicians and lifesaving treatments.”

Comfort meets efficiency

Although the home-care model isn’t entirely new, it has been growing since the COVID-19 pandemic, when Medicare began loosening its regulations and provided a waiver that enabled hospitals to deliver virtual acute care.

Common conditions that can be treated this way include sepsis, decompensated chronic heart failure and COVID-19 pneumonia. Cleveland Clinic contracts with third-party clinicians who visit patients’ homes to perform tasks like setting up intravenous lines, giving medications and assessing patients’ lung sounds — all while remaining in virtual contact with clinical staff at CIViC.

Both patients and nurses love the benefits virtual care provides, says Program Manager Danielle Crow, MSN, RN. “Patients are sleeping in their own beds and are happy to be at home, which has resulted in amazing patient experience scores.”

The at-home model is a welcome change for many nurses who are accustomed to working on hospital units where “they’re moving from room to room to complete task after task,” says Crow. “By working virtually, nurses have the space they need to focus on their patients’ care. This approach really allows us to use our minds and tap into the heart and soul of nursing.”

Walton adds, “The program allows nurses to work at the top of their license. It also provides a great opportunity for exceptionally experienced nurses who are physically unable to tolerate the rigors of hospital work to be productive caregivers.”

Meeting patient needs

About two-thirds of patients in the program come directly from the emergency department; other eligible patients are initially admitted to a participating hospital and then transition to at-home care.

Initially reserved for patients who live within a 30-mile radius of Indian River Hospital, the program has now expanded to four additional Cleveland Clinic locations: Tradition Hospital, Martin North Hospital, Martin South Hospital and Martin Health at St. Lucie West.

Program leaders aim to make at-home care available through all five Cleveland Clinic Florida hospitals. Since 2023, more than 600 patients have been enrolled in the program (approximately 10 per day). The average length of stay is four days, and patients are typically visited twice per day by an at-home provider.

The program is currently staffed by 10 full-time nurses, and seven more are in training. The nurse-to-patient ratio is 1-to-5 — the same ratio seen on most non-ICU hospital floors. In addition, CIViC also staffs a physician hospitalist and pharmacist.

Unique benefits

Those unfamiliar with acute at-home treatment often assume that the virtual model gives caregivers fewer opportunities to interact with their patients, but Crow believes the opposite is true. “Many of our nurses have found that the connections they form with their patients are actually deeper,” she says. “We see our patients’ homes and meet their pets and family members, so there’s an intimacy to our interactions that can’t be replicated in a hospital setting.”

Indeed, that closeness was among the features that attracted Christina Clark, RN, to the program. After a decade working in different hospital units, she says, “The idea of taking care of patients in their own home — the environment where they’re most at ease — was very appealing to me. It’s a pleasure to help patients manage their health at home with the benefit of a robust support system.”

When in their own surroundings, patients are often more willing to follow and participate in their plan of care, adds Clark. “I’ve found that patients are more eager to participate in their care when they have access to their creature comforts and family members. Chores like using an incentive spirometer don’t seem as intimidating when you’re recuperating in your own bed,” she says.

By remaining at home, patients are also able to avoid hospital-acquired
infections, which can have dire consequences for those with weakened immune systems. “Although you may do everything possible to protect vulnerable patients from pathogens, infections remain a serious threat in the hospital setting,” says Crow. “But at home, there’s no such thing as a hospital-acquired infection. It’s a great relief to everyone involved.”