School of Medicine, BJC HealthCare program involves daily check-ins aimed at reducing hospitalizations
People with COVID-19 who are seen by Washington University physicians or BJC Medical Group providers, but not sick enough to be hospitalized, can be enrolled in an in-home health monitoring program.
With daily check-ins for each patient via smartphone app or phone call, the program helps medical professionals identify signs of worsening illness early so they can intervene and, ideally, keep patients out of the hospital.
“One of the tricky things about COVID is that it is so new that we are still learning about the ways the illness can progress,” said Jennifer Schmidt, MD, an assistant professor of medicine at Washington University School of Medicine in St. Louis and one of the program’s organizers. “Sometimes people look like they’re getting better, and then all of a sudden they get worse. Having the patients regularly check in really helps us catch those who are starting to get sicker so we can get them the care that they need. We want to help patients avoid being admitted to the hospital, if possible.”
COVID-19 patients are given the option of installing the My Chart app on their phone or receiving daily phone calls. My Chart is produced by Epic, the electronic medical records system used throughout the BJC network of hospitals. The app pings each patient every morning with a series of questions such as: What is your temperature? How is your cough? Do you have any shortness of breath? How is your appetite?
Those who choose to be called or who don’t respond to the app receive a telephone call from a person who asks the same questions.
“We can get a great deal of useful information just by asking patients to self-report their symptoms,” said Richard Taylor, MD, the chief clinical informatics officer overseeing Epic for both the School of Medicine and BJC HealthCare, and one of the program organizers. “If a patient reports, for example, ‘I’ve got a new cough, and my fever’s getting worse,’ a nurse will call them right back and say, ‘OK, tell us about that.’”
The COVID monitoring program was developed collaboratively by the School of Medicine and BJC. A team of Washington University and BJC Medical Group physicians led by Schmidt spent a few days reading up on how physicians at other institutions have cared for COVID-19 patients. They combined those reports with their own expertise in infectious diseases, pulmonary and critical care medicine, or general medicine to develop a set of criteria that suggests a COVID-19 patient could be taking a turn for the worse.
Taylor coordinated with managers of Epic to build questions about the relevant symptoms into the My Chart app. Megan Guinn, the director of clinical improvement at BJC Medical Group, was brought on board to figure out how the program would be staffed and supported, and BJC Home Care played a critical role as well by providing pulse oximeters to measure oxygen levels in the blood and thermometers for home monitoring. The whole process – from the time the idea of in-home monitoring was floated by Victoria J. Fraser, MD, the Adolphus Busch Professor of Medicine and head of the Department of Medicine, to the time the first patient was enrolled – was implemented in about a week.
A team of BJC and Washington University staff idled by the cancellation of nonurgent medical procedures make the daily phone check-ins and flag any worrisome responses. The app works the same way. Nurses or medical assistants follow up with a phone call and, if necessary, schedule a telemedicine visit with a doctor or nurse practitioner, or advise the patient to come to the hospital for further care.
“We’re following how the process is working in real time,” Schmidt said. “If we would see a lot of people who suddenly have to call 911, that tells us something needs to change so we can catch those people earlier.”
People with COVID-19 who are seen by a Washington University physician or by a provider at a BJC facility are eligible for the in-home monitoring program, including those seen via telemedicine visits or in emergency rooms.
“We want to avoid scenarios where a patient’s condition deteriorates and the health-care provider doesn’t realize it until the patient comes to the emergency room,” Taylor said. “This is something that we think will improve the quality of care so people can stay at home safely.”