Treating acutely ill patients at home: Data from Singapore

Abstract

Introduction: Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes. Methods: We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge. Results: A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3–7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again. Conclusion: Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care. Keywords: Home-based, hospital-at-home, hospital care, internal medicine, public health

Experiences of Patients and Their Caregivers Admitted to a Hospital-at-Home Program in Singapore: a Descriptive Qualitative Study

“…This study is part of an ongoing prospective quasiexperimental cohort study examining the effectiveness of a HaH program in Singapore, NUHS@Home. 15 This program served patients in Western Singapore, admitting patients from two tertiary public hospitalsa 1200-bed academic health intuition and a 300-bed general hospital. Hospital-based clinicians collaborate with private on-demand medical house-call services that provided supplementary and after-hour home visits.…”

Proportion of medical admissions that may be hospitalised at home and their service utilisation patterns: a single-centre, descriptive retrospective cohort study in Singapore

“…It excludes clinical judgement at the point of recruitment and assumes that clinical deterioration requiring intensive care unit admission can be predicted prospectively. Furthermore, it cannot account for the variable acceptance rate among different populations, which various social and cultural contexts and healthcare financing models may influence 20. Finally, it cannot effectively identify social and functional limitations that exclude patients from HaH.…”

Experiences of patients and their caregivers in a Virtual Ward in Singapore: A descriptive qualitative study

“…As the hospital-at-home service of the National University Health System (NUHS) covering Western Singapore, NUHS@Home started Singapore’s first COVID-19 Virtual Ward for high-risk COVID-19 patients to be treated at home [8] . We previously explored the experiences of patients and caregivers of the NUHS@Home program [9] .…”