In our studies, a patient requiring hospital admission for one of the Hospital At Home target illnesses was identified in an emergency room or ambulatory site. The patient’s appropriateness for care in the Hospital At Home was assessed using validated criteria.
If the patient was eligible and consented to Hospital At Home care, he or she was then evaluated by the Hospital At Home physician and transported home, usually by ambulance.
Once home, the patient had direct nursing supervision for the initial portion of their Hospital At Home admission, the duration of which depended on the level of illness acuity, as judged by the physician and nurse. At home, the patient was evaluated by the Hospital At Home physician, who completed an assessment and continued to implement appropriate diagnostic and therapeutic measures. The Hospital At Home physician made at least daily home visits and was available 24 hours a day for any urgent or emergent situation. After round-the-clock nursing was no longer needed, the patient received at least daily nurse visits.
The patient received diagnostic studies such as electrocardiograms and x-rays at home, as well as treatments including oxygen therapy, intravenous fluids, intravenous antibiotics and other medicines, respiratory therapy, pharmacy services, and skilled nursing services. Illness-specific care maps, clinical outcomes evaluations, and specific discharge criteria provided a pathway for care.
Diagnostic studies and therapeutics that could not be provided at home, such as computerized tomography, magnetic resonance imaging, or endoscopy, were available via brief visits to the appropriate resource of the acute hospital.
The patient was treated until stable for discharge at which time he or she was discharged from the Hospital At Home and care reverted to the primary physician.
