Background: Heart failure (HF) is a major contributor to hospitalizations. At our institution, we determined that the average length of stay (LOS) for HF admissions was 0.54 days longer than expected compared to similar hospitals nationwide based on a risk-adjusted methodology. A chart review (n=25 patients) revealed that LOS was often extended due to ongoing intravenous diuresis. The COVID-19 pandemic has led to a strain on capacities in the hospitals, with the organization needing to assess alternate models of care delivery for patients.
Purpose: In efforts to reduce the LOS of HF patients, we employed a Hospital at Home (HAH) model embedded within a clinical care pathway to promote early and safe discharge of these patients while still providing ongoing acute care.
Description: The HAH model allows for patients to be cared for with acute interventions in their domiciles. We utilized the HAH model in 41 HF patients who had daily medication titration needs (intravenous or oral) and/or required electrolyte monitoring. Prior to discharge, patients were referred to the HAH program. Upon discharge, the patients were seen by a telehealth video appointment with a licensed physician with assistance of a visiting, in-home community paramedic. Medical decision making by the physician occurred daily, with plans carried out by the in-home team, similar to daily rounds in the hospital in which a hospitalist communicates a management plan to bedside nursing staff. Plans included measurement of vital signs, administration of intravenous diuretics, and collection of blood samples to monitor electrolytes. Patients were seen until a particular health outcome (e.g. goal weight) was achieved. Preliminary data showed that use of the HAH system resulted in averted emergency department visits (42%), prevented hospitalizations (33%), and shortened hospitalizations (25%). Further data collection and outcome measurements, including LOS, are ongoing.
Conclusions: The HAH model provides a virtual care platform with workflows that mirror routine inpatient care to deliver in-person care supplemented by telemedicine oversight by physicians. Utilization of an HAH model in patients with HF may be an effective and safe way to avert hospital admissions, reduce average LOS in this population and increase hospital capacity, particularly during this COVID-19 pandemic.