Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population

Abstract

Recent trends across Europe show a year‐on‐year increase in the number of patients with acute medical illnesses presenting to hospitals, yet there are no plans for a substantial expansion in acute hospital infrastructure or staffing to address demand. Strategies to meet increasing demand need to consider the fact that there is limited capacity in acute hospitals and focus on new care models in both hospital and community settings. Increasing the efficiency of acute hospital provision by reducing the length of stay entails supporting acute ambulatory care, where patients receive daily acute care interventions but do not stay overnight in the hospitals. This approach may entail daily transfer between home and an acute setting for ongoing treatment, which is unsuitable for some patients living with frailty. Acute hospital at home (HaH) is a care model which, thanks to advances in point of care diagnostic capability, can provide a credible model of acute medical assessment and treatment without the need for hospital transfer. Investment and training to support scaling up of HaH are key strategic aims for integrated healthcare systems.

Colectomy Complicated by High-Output Ileostomy Managed in a Virtual Hybrid Hospital-at-Home Program

“…This case displays an advanced cancer patient who undergoes intestinal surgery and incurs multiple medical complications over an extended but set period of time. The acute management of a complicated patient in a HaH program requires timely and effective access to hospital-level interventions and highly qualified clinical decision-makers to identify patient decompensation promptly, according to the UK HaH Society [ 10 ]. This case report demonstrates how Mayo Clinic's ACH program meets these key characteristics.…”

“…The HaH model is uniquely poised to offer patient-centered care to individuals with complex healthcare needs. HaH allows the patient and care team time to address polypharmacy and avoid excess diagnostic testing and costly ED visits while freeing up hospital bed space for patients who require traditional hospitalization [ 10 , 15 ]. In our case, the patient was discharged after surgery on January 11, 2022, readmitted the same day, then had continued inpatient-level care through March of 2022 followed by moderate level postacute care through the beginning of April 2022.…”

“…Therefore, implementing this model for superutilizers may decrease the hospital burden and diminish the readmission rate while addressing patient depression and anxiety, as demonstrated in randomized clinical trials studies compared to conventional in-hospital care [ 15 ]. Additionally, the evidence of iatrogenic damages related to hospital admission, specifically in the elderly population, supports the implementation of this model of care in the management of chronically ill patients [ 10 ].…”

“…This is particularly relevant for patients with multiple comorbidities already at risk for increased healthcare utilization and readmission. Implementing this innovative model mitigates the increasing demand for traditional hospital beds and the negative aspects associated with lengthy and recurrent hospitalizations [9][10][11][12]. Here, we report the acute and postacute care of a severely ill patient suffering from short gut syndrome with a high ileostomy output and severe protein-calorie malnutrition successfully managed at home through the Mayo Clinic's ACH program.…”

Possible futures of acute medical care in the NHS: a multispecialty approach

“…Point-of-care blood testing, along with POCUS, has increased the possibilities of acute medical care in the patient's home, reducing the need to attend hospital primarily for investigation. 36 Although a wide range of acute medical conditions can be diagnosed and treated in the home, 37 this is not currently a widely developed or deployed model of care in the UK. 38 Physician-led acute 'hospital at home' care models show improved clinical outcomes for older adults with frailty when compared with in-patient admission, in particular reduced incidence of delirium and progression to institutional care.…”