SHM Converge Scientific Abstract ePoster Gallery-Utilization of Hospital at Home Program Improves Bed Capacity for Leukemic Patients

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This project evaluated a hospital-at-home (HaH) model for patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) receiving chemotherapy, who often remain hospitalized for prolonged periods mainly because of delayed blood count recovery. Since the average length of stay for these patients can exceed 30 days, the team sought a way to improve bed capacity while maintaining safe care.<br /><br />A collaborative co-management pathway was created between hospital medicine and hematology teams. Over a six-month review, the team found that 90% of excess days beyond a 14-day benchmark were due to count recovery. Patients with prolonged count recovery were screened for HaH eligibility. Inclusion criteria included being afebrile for 48 hours, needing less than daily transfusions, having a 24-hour caregiver, and reliable transportation. Protocols were also created for managing neutropenic fever and transition back to the hospital if needed.<br /><br />Since July 2024, 30 medically appropriate AML/ALL patients were identified for HaH transition, and 12 were admitted. This saved 64 hospital bed days. Barriers to enrollment included insurance issues (28%), distance (39%), higher patient acuity (22%), or multiple factors (11%). One patient (8.3%) required transfer back to inpatient care due to neutropenic fever and bacteremia. Transfusions were still required in some cases, with one platelet transfusion successfully given at home. No other major toxicities led to rehospitalization.<br /><br />Overall, patients reported a very positive experience and appreciated being able to spend time at home. The project suggests that HaH can safely support selected leukemia patients, improve hospital capacity, and may expand further with additional resources such as at-home transfusions.

Asset Subtitle

Colleen McIntosh

Meta Tag

Author List Ania Krzeczowska, Colleen McIntosh, Corinne Shamehdi, David Swoboda, Joanna Barris, Michael Roberts, Nikesh N. Shah

Category Innovations

Concept Acute Myeloid Leukemia

Concept Acute Lymphoblastic Leukemia

Concept Hospital-at-Home

Concept Chemotherapy

Concept Induction Therapy

Distinguished Non-Finalist

Presenter Organization University of South Florida

Presenting Author Colleen McIntosh

Track Quality Improvement

Keywords

hospital-at-home

acute myeloid leukemia

acute lymphoblastic leukemia

chemotherapy

prolonged hospitalization

blood count recovery

bed capacity

co-management pathway

neutropenic fever

home transfusion

Acute Myeloid Leukemia

Acute Lymphoblastic Leukemia

Hospital-at-Home

Chemotherapy

Induction Therapy