SHM Converge Scientific Abstract ePoster Gallery-Implementing & Adapting Hospital-at-Home at an Academic Medical Center

Pdf Summary

The document describes Oregon Health & Science University’s implementation of a Hospital at Home (HaH) program in November 2021 to address severe inpatient capacity constraints and provide patient-centered care. HaH delivers inpatient-level care in patients’ homes through continuous nursing and provider oversight via telemedicine, with technology, supplies, and hands-on clinical support sent to the home as needed.<br /><br />The program was launched quickly through a partnership with a commercial vendor, but early experience showed that success depended on rapid-cycle improvement and flexibility. The team initially used diagnosis-based admission restrictions, but after the first patient took several weeks to enroll, they shifted to a more individualized screening process focused on whether each patient’s specific care needs could be met at home. This broadened access and improved enrollment.<br /><br />Additional adaptations included:<br />- expanding eligible diagnoses,<br />- adding support for total parenteral nutrition (TPN) and tube feeds,<br />- creating alternative housing through a nearby hotel for patients outside the service area,<br />- and developing a dedicated virtual hospitalist role after telemedicine adoption varied and patient identification required significant provider time.<br /><br />A major operational innovation was using HaH for patients needing outpatient dialysis during a period of severe dialysis nursing shortages. These patients received inpatient care at home while continuing dialysis three times weekly in the hospital, freeing beds and improving throughput. In 6 months, 43 dialysis patients enabled capacity for 167 additional inpatient admissions.<br /><br />Overall, the authors conclude that HaH was an effective strategy for relieving capacity pressure. Key lessons were the importance of flexibility, ongoing process improvement, and focusing on individual patient needs rather than rigid admission criteria.

Asset Subtitle

Ayako Mayo

Meta Tag

Author List Angela E. Alday, Ayako Mayo, Christian O'Keeffe, Jessica Flynn, Matthias Merkel, Stephanie AC Halvorson

Category Innovations

Concept Home-Based Acute Care

Concept Inpatient-Level Care

Concept Inpatient Capacity

Concept Telemedicine

Concept In-home clinical support

Distinguished Non-Finalist

Presenter Organization Ohsu

Presenting Author Ayako Mayo

Track Technology in Hospital Medicine

Keywords

Hospital at Home

Oregon Health & Science University

inpatient capacity

telemedicine

home-based care

patient-centered care

rapid-cycle improvement

dialysis

virtual hospitalist

outpatient admissions

Home-Based Acute Care

Inpatient-Level Care

Inpatient Capacity

Telemedicine

In-home clinical support