Arnita's Story: Bringing Emergency Care to the Home

It's not easy for Arnita Harvey to leave her home. The 80-year-old Charlestown resident is legally blind and lives on the fourth floor of an apartment building. So when she began experiencing congestion and mild breathing difficulties in December 2023, her primary care provider (PCP) at Massachusetts General Hospital made sure she wouldn't have go to a hospital for emergency care. Instead, the hospital came to her.

Arnita received care through Home Hospital Emergency Care (HHEC), a new offering from Mass General Brigham's Healthcare at Home. HHEC enables select patients to be treated in their home rather than at an emergency department (ED) or urgent care clinic. For patients like Arnita, that's a big deal.

"I was thrilled to learn that Mass General Brigham has a service like this," she says. "It's helpful for me because I can't just jump in a car and drive to the emergency room. My experience was extremely positive, and I think it's a great service."

Emergency care at home

HHEC has proven to be particularly helpful for older patients, but there is no age requirement. The service is open to anyone who might benefit from emergency care in the home. In general, patients have conditions that can be safely treated at home. Examples include COVID-19, pneumonia, asthma, flu, dehydration, and urinary tract infections.

Upon their request, patients are referred to the HHEC through their Mass General Brigham PCP. If the PCP thinks the patient needs emergency or urgent care but would be better served by staying home, they make the referral to HHEC.

A nurse with HHEC then confirms with the PCP that the patient is a good candidate. Next, the nurse contacts the patient and, with the patient's consent, schedules a home visit.

"We're really excited to be able to offer this unique service to Mass General Brigham patients so they can receive timely care in their homes instead of visiting a brick-and-mortar ED," says emergency medicine doctor David A. Meguerdichian, MD, interim clinical director of Emergency Services, Healthcare at Home. "It's gratifying to work as a physician in this program. I can take time with patients to ensure that what matters most to them is at the center of the conversation."

A typical Home Hospital Emergency Care visit

For a home visit, HHEC sends out a specially trained paramedic who is assisted virtually by an emergency medicine doctor. The paramedic performs a physical exam, checks vital signs, completes lab work and other diagnostic testing, and more.

Working together, the paramedic and doctor talk with the patient (and any involved family members) and discuss next steps for the patient's care. Once everyone agrees on a plan, it is automatically sent over to the referring PCP.

Tim Lindeman, the paramedic who conducted Arnita’s HHEC visit, joined the service in July 2023 after spending many years in other ED settings. He says that the HHEC model has advantages that a regular ED can't match.

"HHEC gives us the time and ability to focus on caring for the patient's medical needs," he explains. "It also allows us to look around the home and understand why they don't want to leave. Perhaps there are children or a disabled spouse there that no one else can take care of."

A diagnosis and treatment plan at home

During his visit with Arnita, Lindeman checked her oxygen levels and conducted a lung exam and COVID-19 testing. He worked with Justine M. Nagurney, MD, MPH, associate clinical director of Emergency Services, Healthcare at Home, via video chat. They diagnosed Arnita COVID-19 and quickly developed a treatment plan.

"For someone like Arnita, who was against going to the hospital, we were able to go to her home. We tested her at the bedside, came up with and enacted the care plan. We could relieve her of any worries about having to go to the hospital. That's really amazing," says Lindeman.

Work is underway to expand HHEC across Mass General Brigham. Drs. Nagurney and Meguerdichian look forward to bringing the model to more patients.

"With HHEC, we're trying to meet patients where they are, with the right care, at the right time, in the right place. It's all about taking a patient-centered approach,” Dr. Nagurney says.