Opal's Story: Emergency Care Without a Trip to the Emergency Department
No one enjoys a visit to the emergency department (ED). For people who are elderly or find it hard to get around, it's even worse.
Data show that an ED stay can lead to:
Medical complications
Declines in mobility or mental functioning
Emotional stress
Delirium (a mental state of confusion or lack of awareness of surroundings)
Other challenges can include struggles getting to and from the ED and exposure to germs.
"The ED is so disorienting," says John Campbell, MS, NRP, operations manager, Mobile Integrated Health, Mass General Brigham Ambulance Services. "Going there is hard enough for someone young and healthy. It’s even harder for someone who is older, has multiple medical issues, and might have difficulty leaving the home."
Mass General Brigham launched Home Hospital Emergency Care (HHEC) in 2023 as an alternative to the brick-and-mortar ED. The service is part of Mass General Brigham's Healthcare at Home. It allows patients to receive emergency or urgent care at home and avoid having to visit the ED.
A patient-centered approach to emergency care
Patients can request to be referred to the HHEC through their Massachusetts General Brigham primary care provider (PCP). If the PCP thinks the patient requires emergency or urgent care, but are stable enough to remain home, they make a referral to HHEC.
A nurse with HHEC speaks with the PCP to confirm the patient is a good candidate. If the patient agrees to the plan, the nurse schedules a home visit. During the visit, a specially trained paramedic completes a physical exam. This can include checking vital signs and additional lab work or diagnostic testing. A board-certified emergency medicine doctor joins the session via a video call.
Along with the patient and any involved family members, the paramedic and doctor figure out a treatment plan. These details are automatically forwarded to the referring PCP. If needed, the patient may be transferred to a hospital's ED for further care.
"The overarching goal of Healthcare at Home is to deliver care where it's most beneficial to the patient—in their home," says Justine M. Nagurney, MD, MPH, associate clinical director of Emergency Services, Healthcare at Home. "We're trying to put patients at the center of the health care experience. This is critical to improving patient outcomes."
"We want to remove the burden of going to the emergency department by taking care of patients in the home," Campbell adds. "That's where they are happiest, most comfortable, and heal best."
Emergency medical care at home
Opal Briggs is a 91-year-old widow who lives in Boston's Mattapan neighborhood. Two full-time home health aides provide care for her, and family members visit often. But sometimes she needs a higher level of care.
In December 2023, Opal’s physical therapist noticed that her oxygen level was a little low. Typically, that observation would lead to an ED visit for an evaluation.
In this case, though, Opal's PCP referred her case to HHEC. During the home visit, paramedic Mary Anselmo, aided remotely by Dr. Nagurney, performed tests that showed everything was okay. Further monitoring would be necessary; a trip to the hospital would not.
"I've had to take her to the emergency room two or three times. One time, we were there for eight hours," says Opal's granddaughter, Jenelle Johnson. "With HHEC, the paramedic brought all the equipment and did all the testing right in the home. Having them come out here was so much less burdensome for her. It's a great program."
Improving access to emergency care
At a time when EDs are more crowded than ever, Mass General Brigham is working to expand the capacity of HHEC to make it available to many more patients.
"There are many patients who are being seen in the ED when some other sort of care might be more appropriate," Campbell says. "With HHEC, we're trying to give them an alternative, to be that middle ground between not seeking care at all and going to the ED when it might be unnecessary."
Dr. Nagurney believes it has already had a huge impact in its first year.
"Patients and families have both expressed that being able to access the care they need in the home is of tremendous value," she concludes. "As a clinician, I find it incredibly heartwarming to be part of this. It just feels like we're doing the right thing."