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

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.

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

Future Microbiology ◽

10.2217/fmb.15.141 ◽

2016 ◽

Vol 11 (3) ◽

pp. 375-390 ◽

Cited By ~ 17

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

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Re-purposing of domestic steam disinfectors within the Hospital-at-Home setting: Reconciliation of steam disinfector thermal performance against SARS- CoV-2 (COVID-19), norovirus and other viruses’ thermal susceptibilities

Infection Disease & Health ◽

10.1016/j.idh.2021.01.001 ◽

2021 ◽

Author(s):

Beverley C. Millar ◽

John E. Moore

Keyword(s):

Thermal Performance ◽

Home Setting ◽

Hospital At Home ◽

At Home

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Acute Care in the Home Setting: Hospital at Home

Geriatric Practice ◽

10.1007/978-3-030-19625-7_32 ◽

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

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

Home Health Care Management & Practice ◽

10.1177/1084822320988513 ◽

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.

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

Revista Española de Quimioterapia ◽

10.37201/req/122.2020 ◽

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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Hospital at Home: Setting a Regulatory Course to Ensure Safe, High-Quality Care

The Joint Commission Journal on Quality and Patient Safety ◽

10.1016/j.jcjq.2021.12.003 ◽

2021 ◽

Author(s):

Linda V. DeCherrie ◽

Bruce Leff ◽

David M. Levine ◽

Albert Siu

Keyword(s):

Quality Care ◽

High Quality ◽

Home Setting ◽

High Quality Care ◽

Hospital At Home ◽

At Home

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A systematic review of the physical activity levels of acutely ill older adults in Hospital At Home settings: an under-researched field

European Geriatric Medicine ◽

10.1007/s41999-020-00414-y ◽

2020 ◽

Author(s):

Jennifer Scott ◽

Ukachukwu O. Abaraogu ◽

Graham Ellis ◽

Maria Giné-Garriga ◽

Dawn A. Skelton

Keyword(s):

Physical Activity ◽

Older Adults ◽

Older Patients ◽

Functional Change ◽

Hospital Inpatient ◽

Activity Levels ◽

Home Setting ◽

Physical Activity Levels ◽

Hospital At Home ◽

At Home

Abstract Purpose The purpose of this review was to identify, evaluate and synthesise existing evidence reporting the physical activity levels of acutely ill older patients in a ‘Hospital At Home’ setting and compare this to patients with similar characteristics treated in a traditional hospital inpatient setting. Functional changes and any adverse outcomes due to physical activity (e.g. falls) in both settings where PA was reported or recorded were also evaluated as secondary outcomes. Methods A search strategy was devised for the MEDLINE, CINAHL, AMed, PEDRO, OT Seeker and Cochrane databases. Search results were title, abstract and full-text reviewed by two independent researchers. Data were extracted from included articles using a custom form and assessed for quality and risk of bias using the Appraisal Tool for Cross-Sectional Studies. Results No studies set in the Hospital at Home environments were identified. 16 hospital inpatient studies met the criteria for inclusion. Older patients managed in inpatient settings that would be eligible for Hospital at Home services spent 6.6% of their day active and undertook only 881.8 daily steps. Functional change was reported in four studies with both improvement and decline during admission reported. Conclusion There is a lack of published research on the physical activity levels of acutely-ill older adults in Hospital at Home settings. This review has identified a baseline level of activity for older acutely ill patients that would be suitable for Hospital at Home treatment. This data could be used as a basis of comparison in future hospital at home studies, which should also include functional change outcomes to further explore the relationship between physical inactivity and functional decline.

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Music therapy in the Hospital-at-home: A practice for children in palliative care

British Journal of Music Therapy ◽

10.1177/13594575211029109 ◽

2021 ◽

pp. 135945752110291

Author(s):

Tone Leineboe Steinhardt ◽

Sofie Mortvedt ◽

Gro Trondalen

Keyword(s):

Palliative Care ◽

Music Therapy ◽

Allied Health Professionals ◽

Home Setting ◽

Music Therapist ◽

Hospital At Home ◽

The Relationship ◽

Therapy Sessions ◽

Multidisciplinary Teamwork ◽

At Home

This pilot research study investigated music therapy in a hospital-at-home setting for children in palliative care, focusing on parental and nurses experiences of music therapy. Nine families included in the study were interviewed after receiving a maximum of five individual music therapy sessions at home with a Music Therapist. In addition, a focus group interview with allied health professionals involved in the patients’ care was conducted investigating the multidisciplinary team’s experiences with music therapy. Results revealed that the families drew attention to the feeling of being isolated–yet connected due to music therapy. All the families reported the importance of the relationship to the Music Therapist, while emphasizing flexibility and joint music-making. Music therapy within hospital-at-home treatment was reported as a meaningful and much appreciated form of therapy, while the multidisciplinary teamwork was highly valued by both the health personnel and the families. The results showed the need for a highly skilled Music Therapist to support the families’ complex and dynamic needs within a hospital-at-home setting. The results demonstrated the need for, and the possibilities of, a dynamic music therapy programme adapting not only to the patients’ individual needs but additionally providing family-centred care that considered shifting locations.

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