Potential impact of hospital at home on postoperative readmissions

Foley, Olivia W.; Ferris, Timothy G.; Thompson, Rachel; Heng, Marilyn; Ricciardi, Rocco; Carmen, Marcela G. del; Safavi, Kyan

doi:10.37765/ajmc.2021.88797

Cited by 8 publications

(5 citation statements)

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“…Although HAH is distinctly different from HHD, which replaces an inpatient service rather than an outpatient service, the data reporting that HAH is safe and effective is promising to suggest the management of patients with acute medical illness in a home setting is safe [ 59 – 61 ]. Nevertheless, the data on safety is still relatively limited, and management in the home setting should be considered as supplementation to a healthcare facility rather than replacement in suitable individuals [ 62 ]. World-wide, there are different approaches to HHD, with some centers restricting access to programs for patients living alone, whereas others provide assistance at home, and even help with access cannulation and decannulation.…”

Section: Discussionmentioning

confidence: 99%

Risk assessment of failure during transitioning from in-centre to home haemodialysis

et al. 2022

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Background Introducing a de-novo home haemodialysis (HHD) program often raises safety concerns as errors could potentially lead to serious adverse events. Despite the complexity of performing haemodialysis at home without the supervision of healthcare staff, HHD has a good safety record. We aim to pre-emptively identify and reduce the risks to our new HHD program by risk assessment and using failure mode and effects analysis (FMEA) to identify potential defects in the design and planning of HHD. Methods We performed a general risk assessment of failure during transitioning from in-centre to HHD with a failure mode and effects analysis focused on the highest areas of failure. We collaborated with key team members from a well-established HHD program and one HHD patient. Risk assessment was conducted separately and then through video conference meetings for joint deliberation. We listed all key processes, sub-processes, step and then identified failure mode by scoring based on risk priority numbers. Solutions were then designed to eliminate and mitigate risk. Results Transitioning to HHD was found to have the highest risk of failure with 3 main processes and 34 steps. We identified a total of 59 areas with potential failures. The median and mean risk priority number (RPN) scores from failure mode effect analysis were 5 and 38, with the highest RPN related to vascular access at 256. As many failure modes with high RPN scores were related to vascular access, we focussed on FMEA by identifying the risk mitigation strategies and possible solutions in all 9 areas in access-related medical emergencies in a bundled- approach. We discussed, the risk reduction areas of setting up HHD and how to address incidents that occurred and those not preventable. Conclusions We developed a safety framework for a de-novo HHD program by performing FMEA in high-risk areas. The involvement of two teams with different clinical experience for HHD allowed us to successfully pre-emptively identify risks and develop solutions.

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Section: Discussionmentioning

confidence: 99%

Risk assessment of failure during transitioning from in-centre to home haemodialysis

et al. 2022

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“…While the strain on hospital access and social distancing and isolation may lessen, patients in remote areas of the country will still require access to transplant centers. These can be opportunities to explore and to develop acute hospital at home models, which have been shown to reduce readmissions and cost while improving patient experience following non-transplant surgeries (136)(137)(138)(139).…”

Section: Telemedicine In Post-operative Carementioning

confidence: 99%

The impact of COVID-19 on kidney transplant care

Zhang

Kodali²,

Mour³

et al. 2023

Front. Med.

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The SARS-CoV-2 virus precipitated the coronavirus 2019 (COVID-19) pandemic, which placed considerable strain on healthcare systems and necessitated immediate and rapid alterations in the delivery of healthcare. In the transplant population, COVID-19 directly impacts an inherently vulnerable population in the setting of immunosuppression and co-morbidities, but also further complicates the clinical evaluation and management of kidney transplant candidates and recipients in a strained healthcare environment being challenged by the pandemic. Many transplant centers around the world saw mortality rate spikes in organ recipients related to COVID-19, and changes in care delivery abound. This review evaluates the care of the kidney transplant patient through all phases of the process including pre-operative evaluations, perioperative care, post-transplantation considerations, and how the global pandemic has changed the way we care for our patients.

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“…In 1999, a study found that the HaH program was safe and effective in acutely ill elderly patients [ 2 ]. As the name suggests, HaH is an integrated system bringing care that is traditionally rendered inside of hospitals—daily physician or nurse visits (generally at least twice daily), monitoring vital signs, laboratory testing, intravenous fluids, and medication administration to patient homes, with the added provision of a hospital transfer, if the patient needs one [ 3 ]. Therefore, HaH provides an alternative venue for patients requiring inpatient care, which decompresses traditional hospitals to allow the sickest patients to be cared for there.…”

Section: Introductionmentioning

confidence: 99%

Hospital at home: emergence of a high-value model of care delivery

et al. 2023

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Background With increasing healthcare demands for acute illness in patients especially in the times of pandemic, healthcare organizations require modern solutions. Hospital at home (HaH) is one such tool that has the potential to solve these problems without compromising the care of the patients. Main body Hospitals have been the conventional setting for managing acute sickness patients; however, it could be a very challenging environment for a few patients, especially for the older population who are highly susceptible to hospital-acquired infections. Health care in a hospital setting can also be very expensive, as it often involves a lot of healthcare professionals providing care. HaH service can provide the same quality of care expected in traditional settings. Conclusions The median length of stay and the rate of readmissions were lower in people under HaH care. Compared with patients in a hospital setting, patients in HaH had better clinical outcomes. HaH unit provides an integrated, flexible, easy-to-scale platform that can be cost-effectively adapted to high-demand situations.

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Potential impact of hospital at home on postoperative readmissions

Cited by 8 publications

References 0 publications

Risk assessment of failure during transitioning from in-centre to home haemodialysis

Risk assessment of failure during transitioning from in-centre to home haemodialysis

The impact of COVID-19 on kidney transplant care

Hospital at home: emergence of a high-value model of care delivery

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