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 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 Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department

2021 ◽  
Vol 4 (6) ◽  
pp. e2111568
Author(s):  
Geneviève Arsenault-Lapierre ◽  
Mary Henein ◽  
Dina Gaid ◽  
Mélanie Le Berre ◽  
Genevieve Gore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Disease ◽  
Hospital Stay ◽  
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

Cholestatic syndrome in viral hepatitis A

Folia Medica ◽  
2012 ◽  
Vol 54 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Andrey I. Petrov ◽  
Nikolay T. Vatev ◽  
Maria V. Atanasova
Keyword(s):  
Hospital Stay ◽  
Viral Hepatitis ◽  
Hepatitis A ◽  
High Morbidity ◽  
Transaminase Activity ◽  
Ultrasound Monitoring ◽  
High Morbidity Rate ◽  
The Mean ◽  
Viral Hepatitis A ◽  
Cholestatic Syndrome

ABSTRACT AIM: To study the cholestatic forms of viral hepatitis A that are described as unusual and very rare, but that are of great signifi cance because of their severe course and high morbidity rate. MATERIAL AND METHODS: We describe herein 17 cases of hepatitis A virus (HAV) infection with pronounced cholestasis treated in the Clinic of Infectious Diseases at St. George University Hospital between 2002 and 2006. They are taken from a contingent of 820 patients we studied in the course of the research: of these 400 were cases of sporadic disease and 420 patients were involved in an epidemic outbreak of the disease. All got this diagnosis based on an anti-HAV/IgM test. Eight parameters were analyzed: age, max TBil, max ALT, ALP, GGT, no urobilinogen in urine, ultrasound monitoring of hepatomegaly, and hospital stay. RESULTS: The 17 patients we discuss here are 2.07% of the total 820 patients with viral hepatitis A (VHA). In 14 the disease had a cholestatic component; 3 cases were a cholestatic form of the disease. The mean hospital stay was 49.1 ± 11.5 days, the longest - 75 days. The hyperbilirubinemia had high levels at the disease climax - the mean concentration was 356.6 μkmol/l, and remained greater than 150 μkmol/l for more than a month. In 10 patients (58.2%) transaminase activity was over 1400 U/l, (mean 2011 U/l). CONCLUSION: Viral hepatitis A ran with cholestatic syndrome in 2.07%; 23.5% of these cases were classifi ed as severe forms of the disease and 76.5% - as moderate. This is evinced by the enhanced transaminase activity, the elevated TBil, pronounced intoxication, the adynamia, vomiting, headache, the vertigo, all of these items in the objective severity score system we used.

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

The effectiveness, acceptability and costs of a hospital-at-home service compared with acute hospital care: a randomized controlled trial

2005 ◽  
Vol 10 (3) ◽  
pp. 158-166 ◽  
Author(s):  
Roger Harris ◽  
Toni Ashton ◽  
Joanna Broad ◽  
Gary Connolly ◽  
David Richmond
Keyword(s):  
Health Outcome ◽  
Hospital Care ◽  
Inpatient Care ◽  
Acute Hospital ◽  
Full Capacity ◽  
The Mean ◽  
Care At Home ◽  
Hospital At Home ◽  
Mean Cost ◽  
At Home

Objective: To compare the safety, effectiveness, acceptability and costs of a hospital-at-home programme with usual acute hospital inpatient care. Method: Patients aged 55 years or over being treated for an acute medical problem were randomized to receive either standard inpatient hospital care or hospital-at-home care. Follow-up was for 90 days after randomization. Health outcome measures included physical and mental function, self-rated recovery, health status as assessed by the SF-36, adverse events and readmissions to hospital. Acceptability was assessed using satisfaction surveys and the Carer Strain Index. Costs comprised hospital care, care in the home, community services, general practitioner services and personal health care expenses. Results: In all, 285 people were randomized with a mean age of 80 years. There were no significant differences in health outcome measures between the two randomized groups. Significantly more patients receiving care at home reported high levels of satisfaction, as did more of their relatives. Relatives of the care-at-home group also reported significantly lower scores on the Carer Strain Index. However, the mean cost per patient was almost twice for patients treated at home (NZ$6524) as for standard hospital care (NZ$3525). A sensitivity analysis indicated that, if the service providing care in the home had been operating at full capacity, the mean cost per patient episode would have been similar for both modes of care. Conclusions: This hospital-at-home programme was found to be more acceptable and as effective and safe as inpatient care. While caring for patients at home was significantly more costly than standard inpatient care, this was largely due to the hospital-at-home programme not operating at full capacity.

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