Hospital-at-Home Expands Hospital Capacity During COVID-19 Pandemic.
Xavier Nogués, Francisca Sánchez-Martinez, Xavier Castells and 7 others
PMID 33639115WHAT IT FOUND
917 carefully selected patients with COVID-19 were managed at home with telephone monitoring and reported oxygen saturation when needed, adding hospital capacity. 57 needed emergency referral, and 1 died, so this was a single-center service experience, not proof for sicker patients.
Key findings
01917 patients were admitted to the Hospital-at-Home service, and 634 inpatient hospital care patients were reported for comparison.
0257 patients were referred back to the emergency department for clinical worsening, 10 of those were re-admitted to conventional wards, and 1 patient died while in the service.
03The service added 12,297 bed-days to hospital capacity during the study period.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Patients selected for home care had to be stable, age 75 years or younger, and able to isolate at home, so results do not apply to more severe or frail patients. The Hospital-at-Home group and the inpatient group were not comparable because admission criteria differed and the home group was clearly less severe. Routine follow-up was by telephone and patient-reported oxygen values, with no direct observation of most patients. This was a single-center experience, so other hospitals may need different staffing, criteria, and transfer pathways. The paper reports a service experience and does not test whether Hospital-at-Home caused better outcomes than usual care.
The easy way to misread this
Do not read the reported outcomes as proof that Hospital-at-Home is safe for all patients with COVID-19. The home group was selected for milder, stable illness and was monitored remotely, not directly observed.