The Journey Home: Supporting Patients with COVID-19 After Discharge

Patients with COVID-19 often require home care to help with their recovery after leaving the hospital. Clinicians at NYU Winthrop Hospital are using Epic to plan for these needs and monitor patients as they recover.

“For patients with COVID-19, life after hospitalization can look very different from before,” said nurse supervisor Debra Tracy. “We have patients who now need home oxygen and a walker, and we need to help them adjust.”

During a patient’s hospital stay, nurse supervisors and case managers document the equipment a patient will need at home—such as a portable oxygen machine—in the Epic chart. The entire care team can see these needs to help plan for discharge. For example, home health nurses can track which patients will need care in the home to inform staffing. 

Within 24 hours of the patient’s return home, a field coordinator sets up a tablet for the patient to record blood pressure, heart rate, and oxygen readings. The readings are sent to home health nurses to review in Epic so they can quickly call the patient to address any concerns. This monitoring continues until the patient is fully recovered.

“It’s always a celebration when a patient with COVID-19 goes home,” said nurse Katisha Gordon. “As a field coordinator getting patients set up for home recovery, I can help that journey back to their normal lifestyle go more smoothly.”

Epic community members can read more about monitoring patients in the home in the Managing Coronavirus Disease (COVID-19) With Epic documentation on the UserWeb.