Emergency clinicians make difficult decisions about whether patients require hospitalization or can be discharged home. Patients are often admitted or observed in the hospital because safe outpatient care plans cannot be coordinated or patients lack the support necessary to recover safely at home.
Unfortunately, these potentially avoidable admissions strain hospital capacity. In 2018, 25 percent of patients admitted from the emergency department (ED) at Penn Presbyterian Medical Center (PPMC) were discharged within 48 hours - suggesting an opportunity to care for patients entirely outside the hospital walls. We have also found that patients would often prefer to recover from acute illness at home if deemed safe and effective to do so by their provider.
PATH provides a practical alternative to hospitalization for ED patients by expanding the point-of-care options available to physicians and deploying health system resources in the home setting.
First, the program leverages a customized Agent dashboard to identify ED patients under consideration for hospital admissions or observation stays who qualify for home treatment. Once identified, the PATH team collaborates with ED physicians, primary care providers, families, and the patient to develop a personalized outpatient plan.
After discharge, all patients receive a next-day scheduled phone call from the PATH team to monitor symptoms, adjust treatment plans, and address patient or family concerns. Additional PATH services include coordination support to arrange outpatient appointments and testing, home health services for eligible patients, home infusion and laboratory services, and identification of health-related social needs.
Through a series of rapid pilots at PPMC, we demonstrated that PATH could provide patients with the right care in the right place at the right time. In the most recent pilot with 30 patients, the ED boarding time for PATH patients was reduced by an average of eight hours, and hospital occupancy decreased by two bed-days. The vast majority of patients recovered safely at home without returning to the hospital, and patients and providers expressed satisfaction with the program.
PATH is currently completing an extended trial at PPMC and exploring additional pilot interventions at other Penn Medicine hospitals. The team is also working on automating many of the program's services and integrating the model with routine clinical care.
PATH served as a model for the COVID Accelerated Care Pathway, a successful initiative led by CHCI, the Center for Connected Care, Penn Medicine at Home, and the Hospital of the University of Pennsylvania. This initiative created a pathway for moderate-severity patients with COVID-19 requiring hospitalization through specialized management in the ED observation unit and outpatient management through COVID Pulse Enhanced, a customized version of the CHCI COVID Watch program. The PATH team is working with these partners to explore new models that build upon the insights from these efforts.