Abstract
Background
Mayo Clinic’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 Mayo Clinic’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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REFERENCES
- Rapid response systems.Resuscitation. 2018; 128: 191-197
- Hackbarth AD. The 100,000 lives campaign: setting a goal and a deadline for improving health care quality.JAMA. 2006; 295: 324-327
- Part 4: systems of care and continuous quality improvement: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation. 2015; 132: S397-S413
- How a rapid response team is supporting people to remain at home.Nurs Older People. 2015; 27 (18–21): 16
- Use of hospital-based acute care among patients recently discharged from the hospital.JAMA. 2013; 309: 364-371
- Inpatient readmissions and emergency department visits within 30 days of a hospital admission.West J Emerg Med. 2015; 16: 1025-1029
- Early rehospitalizations of frail elderly patients - the role of medications: a clinical, prospective, observational trial.Drug Healthc Patient Saf. 2017; 9: 77-88
- Unscheduled hospital contacts after inpatient discharge: a national observational study of COPD and heart failure patients in England.PLoS One. 2019; 14e0218128
- Hospital revisits within 30 days after discharge for medical conditions targeted by the Hospital Readmissions Reduction Program in the United States: national retrospective analysis.BMJ. 2019; 366: l4563
- Assessment of hospital readmissions from the emergency department after implementation of Medicare's Hospital Readmissions Reduction Program.JAMA Netw Open. 2020; 3e203857
Maniaci MJ, Torres-Guzman RA, Garcia JP, et al. Overall patient experience with a virtual hybrid hospital at home program [published online ahead of print April 22, 2022]. SAGE Open Med doi:10.1177/20503121221092589.
- SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process.BMJ Qual Saf. 2016; 25: 986-992
Fingar KR, Barrett ML, Jiang HJ. A Comparison of All-Cause 7-Day and 30-Day Readmissions, 2014. HCUP Statistical Brief #230. October 2017. Accessed XXXX. Agency for Healthcare Research and Quality. www.hcup-us.ahrq.gov/reports/statbriefs/sb230-7-Day-Versus-30-Day-Readmissions.pdf. Accessed November 24, 2021.
- Reducing all-cause 30-day hospital readmissions for patients presenting with acute heart failure exacerbations: a quality improvement initiative.Cureus. 2020; 12: e7420
- Acute respiratory failure in the elderly: diagnosis and prognosis.Age Ageing. 2008; 37: 251-257
- Increasing outpatient treatment of mild community-acquired pneumonia: systematic review and meta-analysis.Eur Respir J. 2011; 37: 858
30-Day readmission rates to U.S. hospitals. Agency for Healthcare Research and Quality. Accessed November 22, 2021. https://www.ahrq.gov/data/infographics/readmission-rates.html
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 Corrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
