RecruitingNot ApplicableNCT03524222

Home Hospital for Suddenly Ill Adults

Home Hospital for Suddenly Ill Adults: A Clinical Trial

Sponsor

Brigham and Women's Hospital

Enrollment

3,000 participants

Start Date

Jan 18, 2018

Study Type

INTERVENTIONAL

Conditions

Heart Failure Asthma Chronic Kidney Diseases COPD Anticoagulants; Increased Infection Gout Flare Hypertensive Urgency Atrial Fibrillation Rapid

Summary

The investigators propose a home hospital model of care that substitutes for treatment in an acute care hospital. Limited studies of the home hospital model have demonstrated that a sizeable proportion of acute care can be delivered in the home with equal quality and safety, reduced cost, and improved patient experience.

Eligibility

Min Age: 18 Years

Inclusion Criteria5

Resides within either a 5-mile or 20 minute driving radius of emergency department
Has capacity to consent to study OR can assent to study and has proxy who can consent
\>= 18 years-old
Can identify a potential caregiver who agrees to stay with patient for first 24 hours of admission. Caregiver must be competent to call care team if a problem is evident to her/him. After 24 hours, this caregiver should be available for as-needed spot checks on the patient. This criterion may be waived for highly competent patients at the patient and clinician's discretion.
Primary or possible diagnosis of cellulitis, heart failure, complicated urinary tract infection, pneumonia, COPD/asthma, other infection, chronic kidney disease, malignant pain, diabetes and its complications, gout flare, hypertensive urgency, previously diagnosed atrial fibrillation with rapid ventricular response, anticoagulation needs, or a patient who desires only medical management that requires inpatient admission, as determined by the emergency room team.

Exclusion Criteria14

Undomiciled
No working heat (October-April), no working air conditioning if forecast \> 80°F (June-September), or no running water
On methadone requiring daily pickup of medication
In police custody
Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
Domestic violence screen positive
Acute delirium, as determined by the Confusion Assessment Method
Cannot establish peripheral access in emergency department (or access requires ultrasound guidance)
Secondary condition: end-stage renal disease, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
Cannot independently ambulate to bedside commode
As deemed by on-call medical doctor, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
High risk for clinical deterioration
Home hospital census is full (maximum 5 patients at any time)