Background: Hospital at Home (HaH) provides inpatient level of care to patients within their homes and replaces the brick and mortar inpatient experience. Our institution’s HaH program has had incredible success and has enrolled over 2000 patients to date and continues to expand. The growth of our program has allowed us to accept more complex cases that require a multidisciplinary approach to our patient’s care, including subspecialist care.This abstract describes how we leveraged our system Command Center (CC) to create a standardized consultative process for most frequently used medicine subspecialties.
Purpose: Prior to formalizing the consultative process, the HaH service relied on the practice of “curbsiding” inpatient consults for complex cases. To provide patients on HaH the parity in the expert level of care to hospitalized patients in a brick and mortar hospital, we worked with our CC to formalize a synchronous, virtual consultative process. By facilitating prompt specialist consultation, we hoped to minimize the necessity for hospitalization escalation, thereby preserving resources and hospital beds. The ultimate goal is to successfully develop a standardized process for subspecialist consultation on the virtual Hospital at Home Model of care.
Description: To develop the workflow, our HaH service team identified the subspecialty services needed based on our patients’ admission diagnoses and clinical experience. The CC then identified the appropriate staffing resources across the health system and a HaH virtual consultative workflow was developed. This was tested and optimized with the first consult service, Infectious Diseases. Subsequent consult services followed the same workflow and we continued to grow the number of specialties from there.Workflow: • The HAH clinician places a desired consult order through Electronic Medical Record (EMR) with associated urgency.• STAT consult orders are routed to CC for immediate action of connecting the needed consultant with the HaH team. • For routine consult, the HaH team reached out to the designated consult service as per hospital protocol and then per services preference, either a secure chat or telephone conversation occurs.• Video consults are scheduled preferentially, but not exclusively, during morning or afternoon nursing visits. • Video visits are perform using a HIPPA compliant link facilitated by the in home rounding nurse or by the virtual care team.• Communication of recommendations follows usual hospital protocol.Though our consult services began in 2023, we rigorously began tracking in 2024. To date, we have had a total of 341 consults.• Nutrition 226• Infectious disease 42• Endocrinology 22• Cardiology 11• Neurology 5• Hematology and Oncology 3• Nephrology 4• Dermatology 3• Vascular surgery 1• Psychiatry 1• Wound care 1• Pulmonary 21• Urology 1
Conclusions: As Hospital at Home programs across the country expand, patients on HaH are becoming increasingly more complex, mirroring the in-hospital population. Many of these patients require specialized consultation. We have successfully developed a standardized process for a synchronous and virtual subspecialist consultation workflow that is conducive to the HaH model. This can serve as a guide for other institutions seeking to integrate tele-consult into their Hospital at Home Model.
