Abstract
Introduction: Hospital at Home (HAH) is an admission avoidance service where patients receive hospital-level care in their own homes. We conducted a retrospective cohort study to compare patient outcomes in older adults with community-acquired pneumonia (CAP) treated through HAH versus an acute frailty ward in hospital. HAH patients received once daily IV ceftriaxone whereas hospital inpatients were prescribed IV antibiotics as per hospital guidelines.
Method: All patients diagnosed with CAP requiring IV antibiotics under HAH and on an acute frailty ward were identified between January and December 2024. 52 patients discharged from hospital to HAH for continuing treatment of CAP were excluded from analysis. 12 HAH patients admitted to hospital during their HAH admission were also excluded from analysis.
Results: 64 HAH patients (mean age 85 years, average clinical frailty score of 7) and 108 hospital inpatients (mean age of 85 years, average frailty score of 5) were treated for CAP during the study period. Mean National Early Warning Score (NEWS) on admission was 4 for HAH patients compared to 3 for patients presenting to hospital. Average length of IV antibiotic treatment was 4 days under HAH and 5.5 days in hospital.
Average length of stay for patients treated under HAH was 4 versus 14 days in hospital. 17% HAH patients developed an AKI compared to 25% of hospital inpatients. 9% HAH patients developed delirium whilst under HAH compared to 37% inpatients during their hospital stay. 33% HAH were palliative compared to 12% inpatients. 12-month mortality rate of HAH patients was 59% compared to 34% inpatients.
Key Conclusion: HAH offers an effective alternative to inpatient care for older adults with CAP, with shorter treatment duration, fewer complications, and reduced hospital stay. Higher mortality likely reflects greater frailty and palliative focus in the HAH cohort, as opposed to reduced care quality.
Comments
Confidence intervals
This is an interesting project and adds to the current conversation regarding community management of older adults. Certainly this data shows that HAH patients had fewer complications. However, given the relatively small sample size can we say with confidence that treatment duration was reduced without 95% confidence intervals or P values? I also wonder if the length of stay analysis could be confounded by social planning on discharge. Was this investigated as part of your project?
Early supported discharge
Great poster, well done.
It looks like you excluded your early supported discharge step-downs, but given the large number, they are an important group to recognise as their LoS (in hospital) is also significant as they will also have had their risk of hospital associated harm cut too. Do you have any plans to look at that group in more detail?
Thank you for the…
Thank you for the interesting project.
When identifying patients with CAP/LRTI to be managed under HAH, what diagnostic investigations were available and used in the HAH setting?
Antibiotic wise, which ones were most commonly used for inpatients, and were these prescribed in line with hospital CAP guidelines? Were there any data on C. diff infection rates or other antibiotic-related complications?
For the 12 HAH patients who required admission, could you provide more detail please, for example, reasons for escalation, outcomes, and whether these cases were classified as treatment failures?
Do you have data on the 30-day mortality rates compared between the two groups as well?
Admission Avoidance
Really interesting study, particularly as we are looking towards expanding community care services for patients.
The exclusion flowchart was slightly difficult to follow but direct comparison tables between the two groups was easy to interpret. Poster design is really nice without too much information!
I would be interested to know who makes the decision to stop IV antbx/stepdown to oral antibiotics for the HAH patients or whether there is a strict SOP for how many days each patient would have IV antbx for specific diagnoses?
This is a really well-put…
This is a really well-put-together poster. I love how clearly it explains why older adults are at risk in hospital and how treating them at home with IV antibiotics could make such a big difference. The methods and timeframe are easy to understand, and the comparison between Hospital at Home and inpatient care feels really relevant to everyday clinical practice. It’s clear, thoughtful, and genuinely highlights an important area where patient care can be improved. Great work.
Really interesting project from one H@H team to another!
Really interesting project and conclusions made from the data collected. I also work in a H@H team in London and definitely see the benefits of caring for frail patients at home.
I just wondered if you had any data on re-admissions to the 'brick and mortar' hospital as a follow up period following the discharge from patient's H@H treatment?
Thank you
This is a really interesting…
This is a really interesting and useful study highlighting the potential for IV antibiotics at home. I wonder about the perspectives and lived experience of the patients - comparing the patient and family's experiences in each group could be an interesting area for future research. Thank you.
A very good study!Just…
A very good study!
Just wanted to clarify that while selecting patients for HAH, was CURB 65 score used?
Also, when we choose a once daily Ceftriaxone dosing, are there any concerns regarding antibiotic resistance?