SHM Converge Scientific Abstract ePoster Gallery-Expediting Bronchiectasis Admissions Through Hospital-at-Home

Pdf Summary

UNC Health’s Advanced Care at Home (ACH) program, launched in 2021, provides hospital-level care at home under the CMS Acute Hospital Care at Home waiver. Because the waiver requires patients to originate from a hospital emergency department or inpatient bed, patients cannot be directly admitted from home or clinic. This creates challenges for bronchiectasis exacerbations, which are well suited to hospital-at-home care but previously relied on direct admissions that have become harder during hospital capacity shortages.<br /><br />To address these delays, UNC developed a coordinated pathway involving ACH, the Medicine Admitting Officer, and pulmonology/bronchiectasis teams. The process begins before the patient comes to the hospital: pulmonology introduces ACH, refers interested patients, and documents a treatment plan. ACH completes the required clinical screen, followed by a social screen and consent discussion. If the patient agrees, they are instructed to present to the emergency department the next day, with transportation home and ACH admission already scheduled.<br /><br />On arrival, the emergency physician completes any needed pre-transport orders, such as IV antibiotic dosing and drug-level checks. A hospitalist performs the required in-person assessment, and the patient is then transported home. At home, an ACH paramedic sets up equipment, and the ACH hospitalist completes a virtual admission visit, writes orders, and performs the history and physical.<br /><br />This pathway allows UNC to meet waiver requirements while minimizing time spent in the brick-and-mortar hospital. To date, ACH has successfully cared for 13 bronchiectasis patients using this model. The experience suggests that proactive screening and coordination can speed admission, improve patient experience, and help hospitals manage urgent but nonemergent conditions despite capacity constraints.

Asset Subtitle

Patrick M. O'Shea

Meta Tag

Author List Bailey Beauclair, Ila Mapp, Michael Craig, Patrick M. O'Shea, Rachelle Alpern, Teresa Thacker

Category Innovations

Concept Home-Based Acute Care

Concept Bronchiectasis Exacerbation

Concept Admission Workflow

Concept Clinical Screening

Concept CMS Acute Hospital Care at Home Waiver

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Patrick M. O'Shea

Track Other

Keywords

UNC Health

Advanced Care at Home

hospital-at-home

bronchiectasis

CMS waiver

acute hospital care at home

emergency department admission

pulmonology coordination

hospital capacity shortages

virtual admission

Home-Based Acute Care

Bronchiectasis Exacerbation

Admission Workflow

Clinical Screening

CMS Acute Hospital Care at Home Waiver