Background: Hospital at Home (HaH) programs aim to deliver high-quality, patient-centered acute care in the comfort of a patient’s home. However, the decentralized nature of HaH introduces unique operational complexities that can limit both scale and efficiency, particularly within large multi-site health systems. Our system operates a Clinical Command Center (CCC), a 24/7 centralized hub staffed by a multidisciplinary team that manages care, throughput and safety system-wide. The CCC oversees key operational functions including real-time bed management and capacity monitoring, intra-facility and inter-facility transfers, monitoring of key safety alerts/early warning scores, tele-consult coordination, and coordination of discharges to post-acute facilities
Methods: During the rapid growth of our health system’s Hospital at Home program, we identified the need for deeper integration with broader operational infrastructure to overcome barriers to scale. To support continued HaH expansion, we embedded core HaH functions into the CCC’s real-time system-wide decision-making to improve patient throughput, streamline transportation home, increase referrals and early patient identification, and expand access to specialty tele-consults. This approach aimed to bridge decentralized home-based care with centralized operations to optimize overall system capacity.
Results: We evaluated our integration with the CCC using metrics reflecting system alignment and operational efficiency. Using a co-developed programmatic referral algorithm, the CCC’s Central Hospitalist generated a total of 726 HaH referrals, resulting in 98 admissions between January 2025 and May 2025. Over this same time period, roughly 36% of HaH patients while boarding in the Emergency Department. Since launching the CCC partnership, our program established consult services with 20 service lines across ten specialities. Additional operational gains included more consistent transportation coordination and streamlined escalation workflows.
Conclusions: Our experience demonstrates that pairing Hospital at Home with a Clinical Command Center enhances system integration, scalability and operational performance. Key lessons include the value of real-time collaboration with throughput teams, data-driven early patient identification workflows, strengthened consult infrastructure, and centralized coordination of logistics such as transport and escalations. Health systems seeking to scale HaH can replicate this model to align decentralized home-based care with centralized operations oversight, ultimately improving capacity and delivering acute care more efficiently across a health system’s continuum of care.