Background

Home hospital redesigns care by providing hospital-level care at home with clinician visits and continuous biometric monitoring. Prior work in medical patients has shown improved mobility, decreased readmission and cost. We sought to investigate this approach in patients undergoing sleeve gastrectomy - the most commonly performed bariatric operation with a typical 1-2 day hospital length of stay. We present our initial experience.

Methods

Patients (21-55 years old) undergoing sleeve gastrectomy are screened for a randomized controlled trial of home hospital versus usual in-hospital care at an urban academic center. Patients must live within 10 miles of the hospital and have a caregiver at home for the first night. Exclusion criteria include BMI >55; kidney, heart or thromboembolic disease; anticoagulation; and chronic pain/NSAID allergy. Patients are monitored post-operatively for 3 hours before being transported home.

Results

To date, 11 patients have been enrolled. Home hospital patients receive nurse, paramedic, and physician visits. They are continuously monitored and have 24/7 access to their care team. The surgical team conducts telemedicine rounds and orders are written electronically. Patients are seen by an internal medicine physician daily and have scheduled nursing visits to administer fluids and medications. One patient developed severe post-operative hemorrhage that was accurately diagnosed at home by vital sign changes and lab work. The patient was expeditiously transferred to the OR for exploration.

Conclusions

In our early experience, the home hospital care model can be implemented in selected post-operative patients and appears able to respond to major surgical complications effectively.