Clinical Scorecard: Characteristics of Patients and Clinical Results for Acute Pyelonephritis Managed in the Mayo Clinic's Home-Based Care Program

At a Glance

Key Highlights

• 165 patients with AP managed in Mayo Clinic's Advanced Care at Home (ACH) program from 2020 to 2025
• Median length of stay in HaH was 3.1 days with only 4.8% requiring escalation to brick-and-mortar hospital
• No in-program deaths occurred; 17% readmission and 4.8% emergency department visits within 30 days postdischarge

Guideline-Based Recommendations

Diagnosis

• Assess severity of illness using SOI and ROM scores
• Evaluate for sepsis criteria and acute kidney injury on admission
• Identify preexisting genitourinary comorbidities

Management

• Select clinically stable patients with safe home environment and social support for HaH care
• Administer intravenous antibiotics and supportive treatments at home with twice-daily nursing visits and daily advanced provider assessments
• Utilize antimicrobial stewardship and inpatient pharmacists for medication management
• Deploy remote monitoring devices for real-time vital sign tracking
• Ensure rapid escalation protocols and 24/7 physician availability

Monitoring & Follow-up

• Continuous remote monitoring of vital signs including oxygen saturation, blood pressure, and temperature
• Daily multidisciplinary rounds including case management and discharge planning
• Close observation for clinical deterioration with protocols for hospital transfer if needed

Risks

• Potential for clinical deterioration requiring escalation to brick-and-mortar hospital (4.8% observed)
• Risk of readmission within 30 days (17%)
• Emergency department visits within 30 days postdischarge (4.8%)

Patient & Prescribing Data

Adults with acute pyelonephritis including those with moderate to extreme severity and multiple comorbidities

Intravenous antibiotics and supportive care can be safely administered in a home-based setting with appropriate monitoring and infrastructure

Clinical Best Practices

• Careful patient selection based on clinical stability and home environment safety
• Integration of virtual and in-person care with multidisciplinary team coordination
• Use of remote monitoring technology to track patient status in real time
• Embedding antimicrobial stewardship and pharmacy expertise within HaH program
• Establishing rapid escalation pathways to hospital for timely intervention if clinical status worsens

References

• Mayo Clinic Advanced Care at Home Program Outcomes
• Hospital-at-Home Programs and Acute Pyelonephritis Management
• Acute Pyelonephritis Clinical Guidelines