Acute Pediatric Home Hospital Care

Abstract

Pediatric inpatient hospitalization can be lifesaving; yet it also can be costly and fraught with nosocomial risks. As of 2014, health care–related injury, morbidity, disability, or death occurs to 1 in 50 hospitalized children in the United States.1 Some patients are admitted for common illnesses, yet their stay is prolonged by hospital-acquired infection, procedure-related complications, or other detrimental sequelae. As US hospital inpatient and observation units overflow with admissions, a new paradigm is needed to safely transition select lower-acuity cases to the patient’s home. Pediatric home health care in the United States now primarily serves patients with chronic medical needs and those transitioning from hospital to home. Yet a new model can emerge as technology advances whereby children with certain acute illnesses are “admitted home” from the emergency department or outpatient center, with daily direct visits by mobile hospitalists and nurses and telemedicine monitoring as needed. Hospital-comparable services at home could include supplemental oxygen, intravenous fluids or medications, nebulized medications, and select laboratory tests. Pilot programs can target uncomplicated cases of bronchiolitis, wheezing, pneumonia, dehydration, and cellulitis that otherwise would require observation or lower-acuity inpatient care. These 5 diagnoses alone constituted 20% of the ∼2 million US pediatric inpatient hospitalizations in 2012.2 If one-fourth of this cohort met “home hospital” inclusion criteria, 5% of pediatric hospitalizations, or 100 000 children nationwide, could benefit from … Address correspondence to Julia Pian, Harvard Medical School, Harvard University, 25 Shattuck St, Boston, MA 02115. E-mail: julia_pian{at}hms.harvard.edu