Hospital bed replacement for acute care of children at home during the COVID-19 pandemic through a Hospital-in-the-Home programme

Abstract

ObjectivesDuring the COVID-19 pandemic, we expanded our Hospital-in-the-Home (HITH) programme to increase capacity and manage COVID-19-positive children. We aimed to assess impact on overall HITH activity and COVID-19-positive outcomes.DesignProspective comparative cohort study.SettingThe largest paediatric HITH in Australasia, at The Royal Children’s Hospital Melbourne.PatientsChildren 0–18 years admitted to HITH during the pandemic.InterventionWe developed a COVID-19 responsive service, and a guideline for COVID-19-positive patients. We compared overall activity prior to and during the pandemic, and COVID-19-positive admissions with different variants.Main outcomesWe compared outcomes for all HITH patients before and during the pandemic, and for COVID-19-positive patients admitted first to hospital versus directly to HITH.ResultsHITH managed 7319 patients from March 2020 to March 2022, a 21% increase to previously, with a 132% telehealth increase. 421 COVID-19-positive patients (3 days–18.9 years) were admitted to HITH, predominantly high risk (63%) or moderately unwell (33%). Rates of childhood infection in Victoria, with proportion admitted to HITH were: original/alpha variant—3/100 000/month, 0.7%; delta—92/100 000/month, 0.8%; omicron—593/100 000/month, 0.3%. Eligible parents of only 29 of 71 (41%) high-risk children were vaccinated. COVID-19-positive children admitted directly to HITH were less likely to receive COVID-19-specific treatment than those admitted to hospital first (14 of 113 (12%) vs 33 of 46 (72%), p<0.001), reflecting more severe respiratory, but not other features in inpatients. 15 of 159 (10%) were readmitted to hospital, but none deteriorated rapidly.ConclusionsCOVID-19-positive children at high risk or with moderate symptoms can be managed safely via HITH at home, the ideal place for children during the pandemic.

Burden of paediatric hospitalisations to the health care system, child and family: a systematic review of Australian studies (1990–2022)

“…These included length of hospital stay (LoS), re-admission rates and healthcare costs. 5 However, the evidence supporting these models and systems is still in its early stages. Research has not extensively evaluated whether the decreased costs resulting from these systems outweigh the development and implementation costs associated with such systems.…”