MGH EM Virtual Observation Unit (VOU)
The Virtual Observation Unit (VOU) and Home-Based Care Options at MGH offer innovative healthcare services ranging from home-based urgent care to in-home assessments and treatments. Specially trained paramedics utilize a Mobile Integrated Health platform to deliver care, including exams, EKGs, lab testing, phlebotomy, and more. The programs aim to reduce ED/EDOU length-of-stay, create hospital capacity, and provide targeted clinical pathways with specialty collaborators. With virtual support available 24/7, these initiatives enhance patient outcomes and accessibility to healthcare.
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Presentation Transcript
MGH EM Virtual Observation Unit (VOU) Regis College President s Lecture Series October 6, 2022
MGH Home-Based Care Options Mobile Response Program (MRP): Home-based urgent care (ambulatory-focused) with the goal of keeping appropriate patients out of the ED. Virtual Observation Unit (VOU): Home-based observation level care for ED/EDOU patients (following ED evaluation), with the goals of reducing ED/EDOU length-of-stay and creating capacity. Home Hospital (HH): Home-based inpatient level of care for appropriate patients requiring additional resources, with the goal of creating hospital inpatient capacity.
Mobile Response Program Specially trained paramedics utilizing a Mobile Integrated Health (MIH) platform to perform in-home assessments/treatments Capabilities: Exam, EKG, point-of-care lab testing, formal phlebotomy, IV access, oral/IV/inhalational medications MIH evaluation + EM attending physician video visit Virtual support from Emergency Physicians 24/7 7 days/week, 8a-8p enrollment Targeted clinical pathways with specialty collaborators
Virtual Observation Unit Specially trained paramedics utilizing a Mobile Integrated Health (MIH) platform to perform in-home assessments/treatments Capabilities: Exam, EKG, point-of-care lab testing, formal phlebotomy, IV access, oral/IV/inhalational medications MIH evaluation, EM attending physician video visit, EM Nurse and Case Management Tech Bag Virtual support from Emergency Physicians 24/7 7 days/week, 8a-8p enrollment Targeted Clinical Pathways with specialty collaborators
Virtual Observation Unit Specially trained paramedics utilizing a Mobile Integrated Health (MIH) platform to perform in-home assessments/treatments Capabilities: Exam, EKG, point-of-care lab testing, formal phlebotomy, IV access, oral/IV/inhalational medications MIH evaluation, EM attending physician video visit, EM Nurse and Case Management Tech Bag Virtual support from Emergency Physicians 24/7 7 days/week, 8a-8p enrollment Targeted Clinical Pathways with specialty collaborators
Virtual Observation Unit Tech Bag Blood pressure monitor Thermometer Pulse oximeter iPad preloaded with CareTeam Connect Mobile hot spot
MRP vs. VOU MRP VOU MGH patients referred by PCP or other outpatient providers Accepted by EM physician MIH visit Disposition: remain at home, ED, Home Hospital MGH ED patients in need of observation/short stay care Accepted by EM physician and nurse MIH visit + Nursing check ins for vitals, reassessment Disposition: remain at home in Obs, discharge, ED, Home Hospital
VOU Inclusion/Exclusion Criteria Inclusion Criteria Age >18 years Resides in Eastern Massachusetts, ideally within Route 128 Lives in secure housing within service area (i.e., not in a shelter) Appropriate for clinical check-ins VOU admission or MRP evaluation between 8am-8pm (MD coverage for care escalations 24/7) Referred from MGH ED or EDOU Diagnosis appropriate for home-based care
VOU Inclusion/Exclusion Criteria Exclusion Criteria Lives beyond interstate 495 Lives in a healthcare facility (Skilled Nursing, Rehab, LTACs) Requires paramedic assessment/treatment more frequently than every 8 hours Awaiting PT/OT/CM for potential placement Acute psychiatric concerns (e.g., suicidal ideation, even if passive) Active substance use Home safety concerns (e.g., intimate partner violence) High-risk features: High Risk Signs: HR >120; SBP <90; Positive Shock Index; SpO2 <93% on ambient air; Increase in O2 requirement new or >2L; RR >28; Diaphoresis High Risk Symptoms: Active chest pain; severe work of breathing; syncope; hemoptysis Requires blood transfusion Requires sensitive exam by paramedic (e.g., rectal exam, genitourinary exam) Requires imaging Deemed high-risk by case management screening assessment when available 6
Virtual Observation Unit (VOU) Pilot August 30 September 12, 2021 2-week pilot (27 patients) 8am-8pm intake Payer blind Clinical case mix Informed FY22 operations model 4
VOU Clinical Conditions Examples of EM VOU conditions: COVID-19 not requiring supplemental oxygen Cystitis or pyelonephritis Acute kidney injury improving with fluids Cellulitis without concern for necrotizing infection, abscess, or compartment syndrome COPD exacerbation not requiring medications more frequently than q4h Volume overload in heart failure not requiring supplemental oxygen Pneumonia not requiring supplemental oxygen Gastroenteritis/gastritis/nausea/vomiting Diverticulitis without abscess or perforation 7
MRP Volume and Outcomes MRP Encounters June 2021-August 2022 MIH Encounters: 978 % patients remaining @ home: 81% Encounters with patients 65y: 765 % of total MRP patients 65y: 78% % patients 65y remaining @ home: 83%
VOU Volume and Outcomes VOU Enrollments January-August 2022 Enrollments: 251 % patients remaining @ home: 84% Enrollments of patients 65y: 154 % of total VOU patients 65y: 61% % patients 65y remaining @ home: 85%
CVOU Patient Experience On a scale from 1-10, with 1 being not at all likely and 10 being highly likely, how likely would you be to recommend the COVID Virtual Observation Unit to your friends and family? 1 (not at all likely) (0, 0.0%) 2 (1, 0.6%) 3 (1, 0.6%) 4 (1, 0.6%) 5 (1, 0.6%) 6 (0, 0.0%) 7 (4, 2.3%) 8 (12, 6.8%) 9 (10, 5.6%) 10 (highly likely) (147, 83.1%
MRP and VOU Pts >65y Remaining at Home % Patients Remaining Home 100% 90% 80% 70% MRP VOU 60% MRP Pts 65yo 50% VOU Pts 65yo 40% 30% 3/5-3/11 4/2 - 4/8 4/16 - 4/22 4/23 - 4/29 5/14 - 5/20 5/21 - 5/27 6/4-6/10 6/11 - 6/17 6/18 - 6/24 7/16 - 7/22 7/23 - 7/29 8/13 - 8/19 8/20 - 8/26 7/2 - 7/8 3/26-4/1 7/30 - 8/5 4/9 - 4/15 5/7 - 5/13 7/9 - 7/15 8/6 - 8/12 3/12-3/18 3/19-3/25 4/30 - 5/6 5/28 - 6/3 6/25 - 7/1 8/27 - 9/2
Questions? Emily M. Hayden, MD, MHPE Director, Telehealth Department of Emergency Medicine Associate Director, Virtual Observation Unit emhayden@mgh.harvard.edu 7
