Acute Care in the Home Setting: Hospital at Home

2019 ◽  
pp. 393-401
Author(s):  
Barbara Morano ◽  
Joanna Jimenez-Mejia ◽  
Martine Sanon ◽  
Carmen Morano ◽  
Linda V. DeCherrie
Keyword(s):  
Acute Care ◽  
Home Setting ◽  
Hospital At Home ◽  
At Home

scholarly journals Connected care for endocarditis and heart failure patients: a hospital-at-home programme

2021 ◽  
Author(s):  
J. van Ramshorst ◽  
M. Duffels ◽  
S. P. M de Boer ◽  
A. Bos-Schaap ◽  
O. Drexhage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Home Care ◽  
Nurse Practitioners ◽  
Care Group ◽  
Proof Of Concept ◽  
Home Setting ◽  
Curative Care ◽  
Care At Home ◽  
Hospital At Home ◽  
At Home

Abstract Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

Intravenous antimicrobial therapy in the hospital-at-home setting: data from the Spanish Outpatient Parenteral Antimicrobial Therapy Registry

2016 ◽  
Vol 11 (3) ◽  
pp. 375-390 ◽  
Author(s):  
Manuel Mirón-Rubio ◽  
Víctor González-Ramallo ◽  
Oriol Estrada-Cuxart ◽  
Pedro Sanroma-Mendizábal ◽  
Antonio Segado-Soriano ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Home Setting ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Hospital At Home ◽  
At Home

scholarly journals Re-purposing of domestic steam disinfectors within the hospital-at-home setting

2020 ◽  
Author(s):  
Beverley C. Millar ◽  
Jonathan Stirling ◽  
Mollie Maguire ◽  
Rachel E. Moore ◽  
Alan Murphy ◽  
...  
Keyword(s):  
Home Setting ◽  
Hospital At Home ◽  
At Home

Infective Endocarditis in a Hospital-at-Home Setting: A Retrospective Analysis in a Peripheral Spanish Hospital

2021 ◽  
pp. 108482232098851
Author(s):  
Rafael Garcia-Carretero ◽  
Oscar Vazquez-Gomez ◽  
Belen Rodriguez-Maya ◽  
Gema Naranjo-Mansilla ◽  
Esther Luna-Heredia
Keyword(s):  
Infective Endocarditis ◽  
Hospital Stay ◽  
Antimicrobial Treatment ◽  
High Morbidity ◽  
Mitral Insufficiency ◽  
Severe Condition ◽  
Home Setting ◽  
The Mean ◽  
Hospital At Home ◽  
At Home

Infective endocarditis (IE) is a severe condition with high morbidity and mortality, and it requires long-term suppressive antibiotic therapy. Outpatient parenteral antimicrobial therapy (OPAT) has been used for a range of infectious diseases for more than 30 years, and in Spain it is used in hospital-at-home (HaH) settings. Our objectives were to describe and characterize the demographic, clinical, and microbiological features of patients admitted to an HaH setting and to assess the safety and effectiveness of OPAT. We conducted a retrospective study that included patients diagnosed with IE over a period of 8 years (2011-2018). We collected demographic and clinical features, length of hospital stay, antimicrobial treatment, microbiological profiles, and outcomes. We included 26 patients during the observation period. Their mean age was 66.5 years, and 88.5% were male. The mean hospital stay was 10.5 days, and the mean stay in the HaH setting was 31 days. A total of 6 patients required readmission due to deterioration, of whom 3 had severe mitral insufficiency. The 8 patients had symptoms of heart failure, but they were treated at home and did not require readmission. Ultimately, 12 patients recovered and were referred to a surgical unit for valvular repair and replacement on a scheduled basis. OPAT is a useful and effective tool for the management of patients diagnosed with IE in HaH settings.

scholarly journals Continuous infusion of antibiotics using elastomeric pumps in the hospital at home setting

2021 ◽  
Author(s):  
Marta García-Queiruga ◽  
◽  
Begoña Feal Cortizas ◽  
Fernando Lamelo Alfonsín ◽  
Sonia Pertega Diaz ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Demographic Data ◽  
Economic Valuation ◽  
Cure Rate ◽  
Nursing Time ◽  
Duration Of Treatment ◽  
Home Setting ◽  
Parenteral Antibiotic ◽  
Hospital At Home ◽  
At Home

Introduction. To describe the avoided costs and to analyze the effectiveness of intravenous antibiotic treatment in continuous perfusion in patients at Hospital at Home Units (HHU) administered using elastomeric infusion pumps (EIP) prepared in a Hospital Pharmacy Service (HPS). Materials and methods. Retrospective observational study of the number and type of EIP prepared in the HPS and of the treated patients. Study period: January 2017-December2018. Analyzed data: demographic data of patients, location of infection, responsible microorganism, medication and type of EIP, dose and duration of treatment and its effectiveness in terms of cure or non-cure or patient’s death. Economic valuation considering: costs of EIP, nursing time needed for preparation and cost of HHU care. Results. A total of 1,688 EIP to treat 102 patients resulted in 106 episodes of outpatient treatment of parenteral antibiotic therapy (OPAT) for 1,409 days, thereby avoiding 1,409 days of hospital admission. A total of 59.8% of the patients were men and the mean age was 70.5 ± 17 years. A 31.1% and 68.9% of the cases were empirical and pathogen-directed treatments, respectively. The most used antimicrobials were piperacillin/tazobactam (42.7%), ceftazidime (24.5%), meropenem (19.8%), ceftolozane/tazobactam (2.8%), and cloxacillin (1.9%). Mean duration of treatment was 13.29 ± 8.60 days. Location of infection: respiratory (42.5%), urinary (17.9%), skin and soft tissue (12.3%), bacteraemia (11.3%), osteomyelitis (7.5%), abdominal (3.8%) and 4.7% in other locations. The cure rate was 84%. Total avoided cost: 580,788.28€ in the 24 months studied. Conclusion. This program represents very important economic savings for the health system, and the effectiveness of the antibiotic treatment has not been compromised.

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