Is home hospitalization of acute patients who are admitted due to infection safe and effective?

Abstract

Introduction: Hospitalization at home (HaD) is a safe, effective and more efficient modality of care than conventional hospitalization (HC). There is little scientific evidence comparing these two models of hospitalization in patients admitted from the Emergency Department (ED) for infection.

Material and methods: Retrospective cohort study between October 1 and December 15, 2023 of patients admitted from the ED for infection. Two cohorts were analyzed, the first one, patients admitted to HC in Internal Medicine, Geriatrics or Infectious Diseases units and the second one, patients admitted to HaD. Patients with hemodynamic instability, those who died in the first 48 h of admission, S. aureus bacteremia, catheter-associated bacteremia, osteoarticular infection, meningitis, diverticulitis, fever without focus, and infections with undrained focus were excluded.

Results: 257 patients were analyzed, 151 in HC and 106 in HaD. The median duration of antibiotherapy was 9 days in HC vs 7 in HaD (p < 0.001), the mean length of stay was longer in HC vs HaD (6 vs 4; p = 0.007). More laboratory tests were performed in HC vs HaD (3 vs 1, p < 0.001), radiographs (11% vs 0%), ultrasound (12% vs 2%) and computed axial tomography (13% vs 3%, p < 0.001). Patients admitted to HC had more confusional syndrome than those admitted to HaD (15% vs 2%; p < 0.001). There were no differences in mortality or readmissions. In the multivariate linear regression analysis, patients admitted to HaD shortened their hospital stay by 1 day (95% CI: -2.2 to -0.185) compared to those admitted to HC.

Conclusion: Patients admitted for infection in HaD from the ED have a shorter hospital stay than patients admitted to HC.