Hospital at Home: Jen’s OHSU story

Collage of three photos: A young child posing with a baby, that baby with a smiling grownup, adult in pool with young child and baby.

Jen Marbach came to OHSU to have her second child in November 2022, after an uneventful pregnancy. Unfortunately, bloodwork showed that her creatinine levels were elevated, indicating a possible issue with her kidneys. Immediately after Jen’s son was born, she lost large amounts of blood and went into kidney failure. She had developed atypical hemolytic uremic syndrome (HUS), a very rare and serious complication of pregnancy.  Instead of going home, she needed to stay in the hospital for intensive treatment and close monitoring.

After two weeks in the hospital, Jen’s bloodwork was looking better. But she was going to need regular dialysis until her kidneys started working again.

Dialysis services in the community have been in very short supply since the pandemic began. The only way for some people to get the treatments they need is by being admitted to the hospital, often for weeks or months. A long hospital stay was hardly ideal for Jen, who had a newborn son and a 6-year-old daughter waiting for her at home.

Instead, she was offered a slot in OHSU’s rapidly expanding Hospital at Home unit, which provides qualified patients with hospital-level care within the comfort of their own homes. For Jen, this meant she could be at home with her husband and young children, bonding with them at a critical time while still having dialysis at OHSU.

“The day of transfer from OHSU on Marquam Hill to Hospital at Home went smoothly,” she said. “I was home by 1:30 p.m. that day.”

Altogether, Jen spent two weeks as a Hospital at Home patient.

“They set up a bunch of equipment, blood pressure machines and so on that all connected to a smart tablet that I used,” she said.

Every day she checked her vitals with the equipment the team installed. The data loaded onto the tablet so the nurses could see her blood pressure, pulse, temperature and oxygen saturation.

Each evening, a courier delivered her medications for the following day. Jen took the medications under nurse supervision.

“The nurses would call via two-way video when meds were due, and I would hold each medication up to the screen,” she said.

Jen also checked in with her doctor via video once a day and received an in-person visit and assessment from a nurse at least once a day. She had 24/7 access to her care team by means of the smart tablet.

“I had an old school, plug-in-the-wall phone that I could call them on or they could call me on directly,” she said. “I could reach someone at any time.”

Three times a week, at around 7 a.m., an ambulance would pick her up at home and shuttle her to OHSU for dialysis.

“Being able to be at home with my kids was very important and just simply being more comfortable in my own bed and my own environment was huge,” she said.

Jen was on a specific diet called a renal diet. It was low in sodium, protein, phosphorus and potassium and  helps protect the kidneys so they don’t have to work so hard.

Learn more about Hospital at Home

“I was happy to follow the diet, but I had more choices and food options at home,” she said. “And the staff were so good – before I left the hospital, they made sure I knew exactly what I could and couldn’t eat and the dietitians were following up online with the nurses to make sure that everything was OK.”

Jen said she felt like the Hospital at Home team prioritized her rest and time with her family.

“The team would make sure my meds were done as soon as they could be so I could get to sleep,” she said. “They wouldn’t call too early because they knew I had a newborn at home. They tried to consolidate visits and care so there was less disturbance in the house.”

Research shows that Hospital at Home patients sleep better, recover faster and are less likely to have to return to the hospital.

After two weeks as a Hospital at Home patient, Jen’s kidney function improved to the point where she no longer needed dialysis and she was discharged. She wants more people to know about Hospital at Home and believes it would benefit a lot of people who, like her, want to get better but don’t want to be in the hospital.

“Everyone advocated for me so well; they saw that somebody with a newborn should be with their baby,” she said. “When I was in the hospital everything was so heavy. Once I got home, my whole mentality was totally different. I was happier.”