Initial Experience With Inpatient Hospital Care at Home for Urologic Disease.

Abstract

In 2020, Mayo Clinic launched Advanced Care at Home (ACH), a hospital-at-home program that cares for high-acuity inpatients via remote monitoring and in-person care. Herein, we describe our initial experience utilizing ACH for patients with urologic problems. We identified ACH patients treated at Mayo Clinic Florida from July 2020 to August 2022. Records were reviewed to identify those with urologic problems, defined as genitourinary infections, urinary tract obstruction, bleeding, or complications following urologic surgery within 90 days of admission. Demographics, Charlson Comorbidity Index, ACH interventions, length of stay, and hospital readmission were assessed. We identified 563 ACH admissions involving 537 patients, of whom 51 (9%) had illnesses with urologic etiology and 3 (0.6%) were admitted for nonurologic postoperative complications following urologic surgery. Admitting diagnoses included pyelonephritis (n = 51, 91%) and epididymoorchitis (n = 2, 4%). Postoperative diagnoses included cellulitis (n = 1, 2%), congestive heart failure (n = 1, 2%), and diverticulitis (n = 1, 2%). Median Charlson Comorbidity Index of admitted patients was 4 (interquartile range: 3-6.8). Twenty-five patients (46%) underwent 38 urologic procedures within 90 days of admission. Interventions included IV antibiotics (n = 51, 91%), IV fluids (n = 12, 21%), IV antifungals (n = 2, 4%), and oral diuretic therapy (n = 1, 2%). Median length of stay was 3 days (interquartile range: 2-4), and 9 patients (16%) were readmitted within 30 days. A total of 216 inpatient hospital days were saved by utilizing ACH. ACH appeared to be a feasible alternative to brick-and-mortar inpatient care for patients with genitourinary infections requiring IV antimicrobials.