The biggest battles that hospitals fight aren’t the broken bones or the serious injuries of accident victims, but rather the chronic diseases that nearly half of all American adults will deal with and which are responsible for 7 out of 10 deaths each year in the United States. The good news is a lot of the expense and complications of these diseases are preventable through encouraging healthier lifestyles and actively monitoring a patient’s situation.
At Beaufort Memorial Hospital, efforts to do just that are already underway through its Bridge to Home care transitions program. Led by Lead Nurse Navigator, Valerie Benn, the program works with care coordinators, physicians, durable medical equipment companies and others to ensure that patients with chronic conditions have the information, tools and resources needed to help them maintain their health and stay out of the hospital.
Benn and her administrative assistant, Dusti Camp, say they’ve also had success incorporating telehealth monitoring into their efforts. They recall one patient in particular, a 50-year-old woman suffering from congestive heart failure, whose care improved dramatically thanks to the new technology.
“She refused our help [initially],” said Camp. “She’d been noncompliant, and we had been unsuccessful at keeping her out of the hospital for more than 30 days at a time. She always refused services.”
Thanks to a new grant, though, the patient was eligible for a home health monitoring system, and Benn was able to convince her to use it. Using this new technology, both the patient and the care providers could track blood pressure, blood sugar data and weight on a day-to-day basis.
“It was a victory for us, because she didn't want anything to do with anyone [before],” says Benn. “We could follow her on a daily basis, and she could see her trends as well. If she gained five pounds in less than a week, she could see the five-pound change and feel the difference.”
“That's one perk that we found with telehealth—getting those weights and blood pressures and glucose scores daily,” explains Camp. “You can see a change sooner and get help to a patient sooner, whether they need a cardiologist or they've just run out of their medication.”
Before using the monitoring system, Benn and Camp’s patient rarely made it more than a few weeks before readmission. Now, thanks to telehealth, she can make it longer stretches.
“It was [still] dicey, because she did gain weight, which could have put her back into congestive heart failure, but we were able to keep her [out of the hospital] for seven weeks this time,” said Benn.
By responding immediately to both the patient’s weight gain and her low supply of prescription drugs, the program was able to provide immediate coaching and call the pharmacy to make sure the drugs were there and that the patient was getting them.
“We were really aggressive about making sure she really knew what to do,” says Camp.
Even in its early stages, it’s clear that telehealth is the way of the future for making a true continuum of care a reality.