A silver lining to the pandemic: At-home care helps patients catch life-threatening illnesses
The coronavirus pandemic might have a silver lining.
With fewer in-person medical appointments and more virtual ones, patients are monitoring their health at home and catching potentially deadly signs and symptoms earlier, spurring a movement to get more monitoring devices into patients’ hands.
“COVID has lit a fire under us,” said Dr. Michael Maniaci, who leads the Advanced Care at Home program at the Mayo Clinic’s campus in Florida.
It’s one of several at-home programs gaining momentum because of the pandemic.
“This opens the potential to re-imagine care in entirely new ways,” said Dr. Peter Pronovost, who started an at-home monitoring program for coronavirus patients in Cleveland. “You can make a hospital at home.”
Mom detects her own preeclampsia
In April, because of Covid-19, Whitney Williams started having fewer in-person appointments with her obstetrician. So the pharmacist from Lexington, Kentucky, decided to start checking her blood pressure daily at home.
One day her blood pressure was high, and Williams called her doctor, who asked her to come into the office. It turns out she had developed preeclampsia, a disorder that can be deadly for mother and baby.
High blood pressure is a signature symptom, and because Williams caught hers in time, she and her baby are fine after long hospitalizations.
“If I hadn’t been checking my blood pressure at home and reporting it to my doctor, who knows if I would have made it to the hospital in time?” Williams wrote in a post on BabyCenter.
Eleni Tsigas, CEO of the foundation, noted that even if doctors return to regular in-person appointments, the cuffs could catch preeclampsia, which comes on suddenly, between visits. Plus, women can check their blood pressure in the weeks following birth, when postpartum preeclampsia can strike and new moms aren’t having frequent doctor’s appointments.
The program had been in the works for months, but the pandemic accelerated its launch, Tsigas said.
“There really is a silver lining to Covid-19,” she said.
A watch-like device helps COVID patients recover at home
When the pandemic began, Dr. Peter Pronovost, chief clinical transformation officer at University Hospitals in Cleveland, was worried about Covid-19 patients recovering at home, away from careful monitoring.
So his hospital sent patients a device that looks like a smart watch, which monitors oxygen levels, pulse, and respiratory rate. The data is electronically monitored by a team of nurses.
Since March, Pronovost’s team has distributed more than 1,000 devices to Ohio patients with confirmed or suspected Covid-19.
The device has already saved the lives of patients like Leonard Frazier, a janitor at a recreation center in Chardon, Ohio. In March, he was at home with coronavirus when his device detected that his oxygen levels were dropping and his blood pressure was spiking. Nurses called him and told him to come the emergency room immediately.
After a week in the hospital, Frazier recovered and was discharged.
“Home monitoring opens up a whole new pipeline for better diagnostics and makes these visible so we can connect people to care,” Pronovost said. “With the ability to monitor patients’ vital signs at home, we can replicate vital signs that are routinely done at the hospital for very low cost at home.”
Pronovost said it’s been “striking” how the pandemic has created “‘the fierce urgency of now,’ as Martin Luther King said. We had to innovate.”
Mayo Clinic starts program with “a lot of Bluetooth devices”
Doctors at the Mayo Clinic started thinking about an at-home monitoring program a year ago, but only last month, with the pressure of Covid-19 at their heels, did the program actually launch.
Now patients are home, loaded up with devices connected by Bluetooth to Mayo nursing stations. The devices check on patients’ heart rate, blood pressure, and oxygen rates. A Bluetooth scale sends in their weight.
Next Mayo hopes to use a virtual stethoscope — patients would place it on their heart and a doctor would listen – and an otoscope, which patients would use to show doctors the inside of their ears and mouths.
“In order to run a hospital at home, you need a lot of Bluetooth devices to turn a bedroom into a hospital room,” said Maniaci, who runs the at home monitoring program at the Mayo Clinic in Florida.
So far, eleven patients in Florida and Wisconsin, with pneumonia, kidney failure, and other diagnoses, are getting care through the program. Mayo hopes to have 60-80 patients in the program by the end of the year, and 600-800 patients by the end of 2021, all monitored by doctors at Mayo campuses in Minnesota, Florida, and Arizona.
“The justification for this was made real by the pandemic,” Maniaci said. “COVID has opened up a realm of virtual medicine that was barely used before.”
Helping patients with diminished access to doctors
Pronovost, the doctor at University Hospitals in Cleveland, said blood pressure cuffs for pregnant women is a perfect example of low-cost, highly effective home monitoring.
“A blood pressure cuff costs between $10 and $30, and we could significantly reduce maternal mortality and neonatal complications, because preeclampsia is a major cause of pre-term birth,” Pronovost said.
The effect could be particularly profound for Black women, who have a higher incidence of preeclampsia and have less access to prenatal care.
“Inequities in maternal mortality and neonatal mortality in non-Whites versus Whites is morally reprehensible,” Pronovost said. “This could be a really effective way of addressing health inequities.
For all expectant moms, careful monitoring can be helpful.
Williams said she’ll always be grateful for her at-home blood pressure cuff.
Because of her preeclampsia, and an associated disorder called HELLP Syndrome, her doctors had to deliver her baby, Emma Rose, six weeks early. Emma spent more than three weeks in the hospital. So did her mother, who suffered a ruptured liver.
“I don’t know that Emma and I would be here today if I hadn’t checked my blood pressure at home and known when to go into the doctor,” she said.