Mass General Brigham Home Hospital Offers a Soft Landing for Patient Post-Ileostomy

After nearly a year of battling colorectal cancer and enduring three surgeries, 52-year-old Nir G. faced a long recovery, including the daily challenges of living with an ileostomy bag. Mass General Brigham Home Hospital was able to make the final stage of his care a little more pleasant.

"I truly believe that having all the comforts of home—my family, my own food, bed, and bathroom—sped up my recovery," said Nir, who is married and has two daughters. "And because of that, my mental health was much better as well."

Early-stage colorectal cancer detected

Because of Nir's age, his primary care doctor at Brigham and Women's Hospital referred him for a colonoscopy. The results, along with an MRI scan at Brigham and Women's, showed he had early-stage colorectal cancer.

The subsequent surgery to remove the tumor from Nir's colon confirmed that the cancer had not spread. During the operation, his surgeon, Joel Goldberg, MD, also performed an ileostomy, which brings the ileum (the lowest part of the small intestine) to the surface of the abdomen to create a stoma. Waste passes through the stoma into an external pouch.

A temporary ileostomy gives the intestines time to heal after the operation. It is typically followed in three months with reversal surgery to reconnect the intestines and close the stoma. However, Nir had unexpected complications that required a second procedure, which delayed the ileostomy reversal.

A couple days before the reversal surgery, Nir got a call from Stephanie Volpe, PA-C, lead surgery physician assistant for Home Hospital. She explained that he might have the chance to shorten his postsurgical stay at Brigham and Women's. Nir was intrigued.

A pioneer in the home hospital model

Mass General Brigham has offered Home Hospital care to eligible patients since 2017. A patient who opts into the program enjoys the convenience of hospital-level care in their own home.

Home Hospital patients are seen twice daily by a nurse and/or paramedic, who can consult with a Mass General Brigham doctor via video call if needed. They are also seen daily by a Home Hospital advanced practice provider or doctor, either in person or virtually, depending on the patient's clinical course.

Stephanie has been involved in efforts to expand Home Hospital to include patients recovering from surgery. Colorectal surgeons at Mass General Brigham say that patients who undergo ileostomy reversals are especially good candidates.

Once Stephanie identifies a surgical patient who could be a good fit for Home Hospital, she contacts their surgeon. If the surgeon agrees, Stephanie reaches out to the patient to explain the program. If the patient prefers to remain in the hospital, they may do so until they are discharged.

"Around the time that Nir had his ileostomy reversal, we were starting to expand our surgical Home Hospital services to include colorectal patients," Stephanie said. "Since he was relatively young and otherwise healthy, I thought he'd be a great candidate."

When discussing the Home Hospital option with patients, Stephanie emphasizes a few key points:

• The surgeon will confirm it is clinically appropriate for the patient to go home and will remain involved in the plan of care throughout their Home Hospital stay.
• The patient will receive the same high-quality care, including medications, that they would in the hospital.
• Providers will handle all necessary wound care in the home.
• Patients who require readmission to the hospital are prioritized for direct admission to the floor, ideally bypassing the Emergency Department.

Nir was reassured by what Stephanie told him about Home Hospital. "Given my age and how long it took for me to recover from my previous surgeries, it just made sense," he said. "I could tell I would be in good hands."

'There's no place like home'

The morning after his ileostomy reversal, Nir was admitted to Home Hospital. Shortly after he returned home, Stephanie arrived to deliver his medications and set up the equipment needed to monitor his vital signs.

Over the next day and a half, several nurses and paramedics from Home Hospital visited Nir. He enjoyed getting to know the providers and noted that the visits never felt rushed. That's very much by design, said Stephanie, who updated Dr. Goldberg on Nir's status at every step.

"Most of my visits with patients last around 30 minutes, and I always call or text them later in the day to check in," she said. "I got into medicine to make connections with patients and provide personalized care, and this program offers a unique opportunity to do that."

On the afternoon of his second day in Home Hospital, Stephanie visited him again to complete the final aspects of his care. She then gave him a clean bill of health and officially discharged him.

For Nir, being part of the Home Hospital program—even for just one or two days—was a positive experience.

"My hospital stays were great—I had an excellent experience both times," he said. "But there's no place like home. When you're in familiar surroundings, and that's paired with just the right amount of high-quality care, it's a win-win."