Home Hospital for Orthopaedic Surgery

Abstract

Home Hospital (HH) is a clinical service involving the delivery of acute inpatient care in the home setting.Acute care services provided via HH include continuous telemonitoring, intravenous fluids and medications, nursing care, point-of-care imaging and laboratory tests, and in-person and virtual clinician visits. Despite offering an inpatient level of care, HH has lower fixed costs and less overhead than conventional hospital settings and offers rapid scalability. Originally implemented for acute medical conditions, HH has proven to be a safe and value-based care-delivery model for a variety of medical conditions, ranging from heart failure to chronic obstructive pulmonary disease exacerbations. For surgical conditions, HH represents an opportunity to reduce adverse hospital-acquired conditions, improve patient and caregiver satisfaction, and decrease cost. The patient profile of orthopaedic surgery inpatients matches that of patients who are most likely to benefit from HH-namely, those who are prone to functional decline, delirium, and nosocomial infections. A focus on surgeon leadership, quality and safety, and digital health with collection of patient-reported outcome measures (PROMs) will ensure that the potential of HH is realized as implementation and widespread rollout proceed.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G792).

Healthcare Value in Plastic Surgery Practice

“…66,67 Home hospital after surgery is less well studied but has the potential to offer postoperative recovery that costs less and enables greater patient satisfaction. [68][69][70] Implementation of home hospital programs for plastic surgery requires the development of evidence-based enrollment criteria, standard pathways of recovery, and quality metrics. In plastic surgery, patients could be evaluated in the preoperative phase for home hospital eligibility along both patient variables (eg, comorbidities) and home-related factors (eg, distance to nearest hospital, home safety), with a final decision made at the time of the operation.…”

“…As previously proposed for orthopedics, quality metrics should include outcomes such as infections, venous thromboembolism, delirium, opioid use, readmission, and PROs. 70 To incentivize the use of alternative care sites, payment policies could be agnostic to the site of care delivery. Under a value-based framework, a given procedure would be reimbursed equally, whether it takes place in the hospital, at an ASC, or with at-home postoperative care.…”

“…As previously proposed for orthopedics, quality metrics should include outcomes such as infections, venous thromboembolism, delirium, opioid use, readmission, and PROs. 70…”