Mass General Brigham launched its postsurgical Home Hospital in 2024 for patients undergoing planned, elective procedures — bariatric surgery, colorectal surgery and nonoperative complicated diverticulitis cases with predictable recovery timelines. Nearly two years later, most of the patients don’t come from a scheduling calendar at all.
Sixty-five percent of the program’s surgical patients now require unplanned surgical care, as the Somerville, Mass.-based health system marks its 500th patient treated through postsurgical Home Hospital. The program has grown to 18 surgical service lines across five hospitals since it admitted its first colorectal surgery patient in 2024, according to Stephanie Volpe, director of advanced practice providers and clinical director of surgical services for the health system’s Home Hospital.
The shift wasn’t part of the original design, Ms. Volpe told Becker’s. The program intentionally began with elective populations that had well-established, transferable care protocols, allowing the team to build its surgical staffing model, identify surgeon champions and develop education for frontline staff before taking on more complex cases.
“Our evolution from condition-specific pathways to a capability-based model has allowed us to safely care for patients with increasingly complex surgical needs at home, which historically would have required a longer hospital stay,” Ms. Volpe said.
As Home Hospital’s capabilities expanded to include complex wound care and nutritional support, inpatient surgical teams began referring more patients overall, Ms. Volpe said.
“If we can provide the care a patient requires at home, we will consider them for the program, regardless of whether they fit within a specific pathway,” she said.
Surgery builds on a broader Home Hospital program that Mass General Brigham has described as the largest in the country, and that has also expanded into oncology care at home and other specialties as the health system works toward moving 10% of its inpatient capacity into patients’ homes.
Operationally, the surgeon remains the attending physician throughout a patient’s Home Hospital stay, mirroring how surgical patients are managed in a traditional hospital, Ms. Volpe said. Surgical advanced practice providers manage patients in the home and communicate directly with surgeons on condition, test results and care plans. Patients use the same 24/7 remote monitoring platform as medical Home Hospital patients, with X-ray and ultrasound imaging available in the home if needed.
Home Hospital nurses and medics see patients at least twice daily, and advanced practice providers evaluate them at least once a day, in person or virtually. Patients also have around-the-clock access to a virtual nursing support line, and a dispatch team can send a medic to a patient’s home, typically within 30 minutes, for urgent needs.
The biggest ongoing operational challenge has been coordinating a seamless handoff for elective surgery patients who interact with multiple teams before their procedure, Ms. Volpe said, since consistent communication about the Home Hospital transition requires close coordination across the care team.
For health system executives evaluating a similar model, the capacity case is central to the pitch. The program has saved more than 1,415 surgical bed days since launch, Ms. Volpe said — capacity that matters most at academic medical centers, where demand for inpatient surgical beds is often high.
Patient response has also shaped the program’s expansion. Mass General Brigham’s Home Hospital has an all-time net promoter score of 84.1, rising to 88.4 in the most recent month, and some patients have specifically requested the surgical Home Hospital service after a prior admission, Ms. Volpe said.
Ms. Volpe’s advice to health systems exploring surgical hospital-at-home: build on established Home Hospital infrastructure, secure engagement from surgical teams and champion surgeons, and start with patient populations that can be safely supported at home before expanding capabilities.
“Success requires strong engagement from brick-and-mortar surgical teams, champion surgeons, and a dedicated team focused on designing and providing care in the home,” she said.
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