Virtual cardiac hospital in the home following cardiac surgery delivers superior patient outcomes, reduces costs, and increases bed availability

Abstract

Abstract Introduction Increasing patient complexity and unprecedented bed access constraints are important challenges in contemporary delivery of post-operative cardiac surgical care. Bed constraints lead to inefficient ICU discharge, excessive hospital Length Of Stay (LOS), and ineffective transitional care which results in suboptimal patient experience and hospital readmissions. The Cardiac Hospital in the Home (cHITH) model was designed to provide an early supported discharge in a virtual ward environment by an expert team of advanced practice cardiac nurses, pharmacists and cardiologists. The model utilizes wearable technology to monitor cardiac rhythm, oxygen saturation and vital signs in conjunction with daily virtual ward rounds using a standard tele health platform. Care is focused on coaching around mobilization and medical therapy, detection and management of complications and liaison with community pharmacies and providers of sub acute care. Escalation pathways for clinical deterioration were designed to support patient safety. Results Between March and October 2022, 123 of 197 patients were referred to cHITH of whom 103 (84%) were recruited. Where appropriate, results were compared with those from the same calendar period in 2021 and dichotomized to detect early trends in care. The cHITH group had a mean age of 62 ± 4 years with 82% males, 62% underwent isolated CABG surgery and there were no mortalities. Compared with historical results, inpatient LOS was reduced 1.6 days with 35% of care delivered in the virtual cardiac hospital. Readmission at 30 days was reduced by 42% (p<0.05)* and patient satisfaction was >90% (net promoter score). Important trends included an increase in cHITH LOS and a reduction in Total LOS. Projections Modelling of total hospital costs and bed-day savings was performed using real data from the medical centre. Assuming that 75% of patients would be managed in the cHITH for 3.5 days, the projected cost of cHITH care was $24.2M comparing favorably with $27.8M for usual care. When readmitted days are subtracted from total virtual care days the cHITH model of care is projected to save 975 inpatient bed days. Conclusions This virtual model of care has demonstrated safety, efficiency and high levels of patient satisfaction. Ongoing analysis is required to understand the broader applications of this model and to further evaluate quality, safety and efficiency metrics.Table 1.Results