Tatiana Castillo had a complicated pregnancy. Around the end of her second trimester, she developed hypertension (high blood pressure). This led to side effects like fatigue (extreme tiredness) and headaches as well as two hospitalizations.
Two days after she gave birth at Massachusetts General Hospital, Tatiana's blood pressure remained very high. She would need to be monitored until it dropped to a normal level. One of her nurses asked if she would like to receive further care through Mass General Brigham Home Hospital.
As an emergency department nurse at Salem Hospital, Tatiana had heard of Home Hospital. However, she didn't know much about the service, which delivers hospital-level care in the patient's home. Upon learning it would allow her to leave the hospital and return to her three other children sooner, she quickly agreed to the plan.
"Just because I worked in a hospital doesn't mean I like being in one as a patient," Tatiana said. "I needed to be with my children. I like to see them when they come home from school. I like to do homework and watch TV with them."
A strong support system at home
Tatiana, who hails from Lynn, Massachusetts, has a history of blood clots and a rare genetic disorder that weakens her immune system. As a high-risk patient, she received prenatal care through Mass General's Maternal-Fetal Medicine Program.
One day in the middle of her third trimester, Tatiana didn't feel well and went to Mass General. Her blood pressure was found to be dangerously high. She was given blood pressure medications and rushed to the Labor & Delivery Unit.
A couple hours later, Tatiana gave birth to a baby boy, Kaiden. He was about five weeks premature and weighed just 4.5 lbs., but he was healthy.
When the nurse later brought up the possibility of Home Hospital, Tatiana had questions. Who would be caring for her? How would her blood pressure be monitored? Would she be as safe as she would be in the hospital? The nurse's answers eased Tatiana's concerns. And given her strong support system at home, the option seemed ideal.
"My mom lives with me, and no one is going to care for me better than her," she said. "And my sister, who lives nearby, is a pediatric ICU (intensive care unit) nurse. So I knew I was going to do fine."
A collaborative approach to patient care
A few hours after going home with Kaiden, Tatiana got a visit from Junhao (Andrew) Yu, a Home Hospital paramedic. In addition to explaining the Home Hospital model, Andrew showed Tatiana how to use the blood pressure monitoring equipment and report her results to her care team. He also reviewed her medications in depth with her.
Over the next few days, the Home Hospital team monitored Tatiana's blood pressure remotely 24/7. Twice daily, a nurse practitioner came by to take her blood pressure and check for abnormal bleeding, swelling, and other issues. A physician assistant, Jennifer Doyschen, PA-C, joined via video during those visits.
"For patients with postpartum hypertension, our main goal is to keep their blood pressure within a range that our obstetrics and Home Hospital teams have set," Jen said. "Once they stay in range for 24 hours, they can be discharged."
Caring for Home Hospital patients is a collaborative effort. Each day, a Home Hospital physician discusses the patient's case with other members of the care team, which may include a medic, nurse, nurse practitioner, and/or physician assistant.
With Tatiana, the clinicians reviewed her blood pressure readings, made medication adjustments, and determined when she would be ready for discharge. Her experience with Home Hospital was everything she had hoped for.
"The care was amazing, and being at home with my kids gave me a sense of relief," said Tatiana, who spent five days in Home Hospital. "And I knew that if I needed help, all I had to do was call and a medic would come out right away."
Choosing to become a Home Hospital caregiver
During her nearly two years with Home Hospital, Jen has seen the program's positive impact on patients' health and well-being.
"They're sleeping in their own bed and eating their own food," she said. "Their family and pets are nearby, which helps with their healing. Overall, patients seem really satisfied."
Tatiana was so impressed with Home Hospital that she went to work for the program five months after her discharge. She now serves as a virtual nurse, sometimes caring for patients with postpartum hypertension.
"Home Hospital is taking an old concept—doctors making house calls to patients—and making it new again through the use of technology," she said. "We're doing a lot for patients, from delivering meals to providing equipment and monitoring in the home, and it's all so well-coordinated. Whoever came up with this system is a genius."
