Building a hospital without walls – Q&A with Karolinska University Hospital

Q: Could you give examples of how Karolinska University Hospital is moving in this direction?

A: Yes, absolutely. One of the most promising involves patients with congestive heart failure, a condition that they can live with for decades. The most common cause for hospital readmission is unrecognized deterioration, while there are actually signs that are quite easy to pick up through remote patient monitoring – including heart rate, blood pressure, and other vital measures, as well as self-reported changes such as weight gain. We have been piloting this approach to learn how we can take better care of patients at home. The results so far have been highly encouraging. Hospital readmission rates for patients with congestive heart failure who are monitored remotely are far lower, although further research is needed.

Another example is how we are trying to reduce post-operative complications in patients who have undergone surgery. Through improved post-operative monitoring in the hospital, we have already been able to identify complications that may otherwise have gone unnoticed and provide better treatment to those patients. As a next step, we plan to extend this monitoring beyond the hospital. This will enable us to safely discharge patients earlier and decrease hospital length of stay, allowing patients to recover in the comfort of their home.

These are just two examples. We are conducting other pilots in home monitoring as well, which involve patients with other chronic conditions, such as atrial fibrillation and COPD. And we see many additional opportunities for remote patient monitoring, for example to address the common challenge of overcrowding in the emergency department (ED). If we can equip patients who don’t need immediate hospital care with technology to monitor how they are doing at home, and if we then remain vigilant for deteriorations in their condition, we could bring patients back into the hospital when needed – making for a more efficient patient flow through the ED while giving patients a better experience.

Q: How do you see the role of healthcare professionals evolving as remote patient monitoring continues to grow?

A: This is a bit speculative, but I imagine that in the future we may have digital wards with healthcare professionals who take care of patients remotely through video calls, chats, and by offering suggestions to support patients at home. Physicians and nurses will do virtual rounds with patients, asking them about any changes in their health and well-being – complemented by data gathered through remote monitoring technology. This will enable care teams to adjust treatment or medication where needed, without patients having to travel to the hospital.

The shift to virtual care could also create new career opportunities for healthcare professionals who are looking for more flexible working hours or workplace flexibility. For example, a nurse could do virtual rounds from home without having to come into the hospital every day. Or healthcare professionals who are on parental leave may want to do a virtual weekend shift once a month when the other parent is taking care of the child. If we can make use of people’s skills in new ways, that could be one way of handling the demographic changes we are seeing in the healthcare workforce and society at large.

Q: As healthcare increasingly moves into the home, how do you envision the role of patient self-assessment?

A: Today, we do a lot of spot-checking in healthcare – meaning we assess how patients are doing physically and mentally every one, three or six months, and we then deduce a lot from those measurements. If we could get a more continuous assessment from the patient perspective, that would allow us to better titrate the patient’s treatment along the way as we gather more information. How is the patient feeling on any given day? Are they enjoying life? Are they experiencing side effects from their treatment?

We have already included initial self-assessment protocols in the pilot for congestive heart failure patients I mentioned before, and it’s something we plan to expand in the future for patients with other chronic diseases. It will enable us to provide appropriate care more preemptively. For example, if we hear from a patient with high blood pressure that they are not sleeping well, we may switch medication more quickly – rather than having to wait until the patient comes in for their next hospital visit.