Hospital at home (HAH) service combining hospital and community care with remote monitoring and daily home visits to replicate inpatient care
Target Population
Patients with heart failure, airway disease, or acute respiratory infection suitable for home-based care, including admission prevention and early supported discharge
Care Setting
Patient's home supported by a partnership between acute hospital and community healthcare providers
Key Highlights
HAH significantly reduced length of stay by 3.13 days compared to matched inpatient controls.
HAH was associated with lower 30-day readmission rates (OR 0.55) and reduced 90-day all-cause mortality (OR 0.43).
HAH yielded net bed-day savings of 13,119 days and cost savings of £3.79 million over 33 months.
Guideline-Based Recommendations
Diagnosis
Patient selection via referrals from emergency, inpatient wards, community specialists, GPs, paramedics, and NHS 111.
Use of electronic patient record queries to identify suitable inpatients based on treatments such as nebulisers, intravenous diuretics, and antibiotics.
Management
Provide real-time remote monitoring using devices like tetherless pulse oximeters linked to a central monitoring hub.
Deliver daily home visits as needed and rapid access to imaging and pathology services.
Multidisciplinary team approach involving doctors, nurses, pharmacists, and allied health professionals.
Operate service 7 days a week aiming to replicate inpatient care at home.
Monitoring & Follow-up
Continuous real-time monitoring of patient observations remotely.
Regular clinical reviews either remotely or face-to-face in the patient's home.
Risks
Exclude patients unable to manage self-monitoring or with physical/mental impairments limiting ability to seek help.
Exclude patients where required medical and care needs cannot be safely delivered at home.
Patient refusal to participate is an exclusion criterion.
Patient & Prescribing Data
Patients with heart failure, airway disease, or acute respiratory infection admitted to hospital or referred from community providers.
HAH supports optimisation of guideline-directed medical therapy for heart failure and management of airway diseases with remote monitoring and home-based care.
Clinical Best Practices
Implement multidisciplinary collaboration between hospital and community healthcare teams.
Use technology-enabled remote monitoring to ensure patient safety and timely intervention.
Proactively identify suitable patients through electronic health records and clinical screening.
Ensure rapid access to diagnostics and specialist input while patients are managed at home.
Maintain patient acceptability and engagement through personalized care and support.
by Michael Shaw, Batool Almogheer, Dominique Auger, Andrew Barlow, Balasmita Bhaskaran, Maria Buxton, Marco Cerulli, Kalpana Giri Ghimire, Edward Hiller, Zoe Jayne, Michal Kelly, Matthew Knight, Eleanor Zinkin, Niall G. Keenan
