Abstract
Background
(ANONYMIZED)’s virtual hybrid hospital-at-home program, Advanced Care at Home (ACH)
monitors acute and post-acute patients for signs of deterioration and institutes a
rapid response (RR) system if detected.
Objective
This study aimed to describe (ANONYMIZED)’s ACH RR team and its effect on emergency department (ED) use and readmission
rates.
Methods
This was a retrospective review of all post-inpatient (restorative phase) ACH patients
admitted from July 6, 2020 through June 30, 2021. If the restorative patient had a
clinical decompensation, an RR was activated. All RR activations were analyzed for
patient demographic characteristics, admitting and escalation diagnosis, time spent
by virtual team on the RR, and whether the RR resulted in transport to the ED or hospital
readmission.
Results
Three hundred and twenty patients were admitted to ACH during the study interval;
230 received restorative care. Seventy-two patients (31.3%) had events that triggered
an RR. Fifty (69.4%) of the RR events were related to the admission diagnosis (p < 0.001; 95% CI 0.59–0.80). Twelve patients (16.7%) required transport to an ED for
further treatment and were readmitted and 60 patients (83.3%) were able to be treated
successfully in the home by the RR team (p < 0.001; 95% CI 0.08–0.25).
Conclusions
The use of an ACH RR team was effective at limiting both escalations back to an ED
and hospital readmissions, as 83% of deteriorating patients were successfully stabilized
and managed in their homes. Implementing a hospital-at-home RR team can reduce the
need for ED use by providing critical resources and carrying out required interventions
to stabilize the patient's condition.
Keywords
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Article info
Publication history
Published online: March 06, 2023
Accepted:
February 17,
2023
Received in revised form:
February 7,
2023
Received:
November 8,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
