Avoiding Escalation to the Emergency Department by Activating an In-Home Rapid Response Team in the 30 Days After Hospital-at-Home Discharge

Background: Mayo Clinic's virtual hybrid hospital-at-home program, Advanced Care at Home (ACH) monitors acute and post-acute patients for signs of deteriora-tion and institutes a rapid response (RR) system if detected.Objective: This study aimed to describe Mayo Clinic's ACH RR team and its effect on emergency department (ED) use and readmission rates. Methods: This was a retrospective re-view of all post-inpatient (restorative phase) ACH patients admitted from July 6, 2020 through June 30, 2021. If the restorative patient had a clinical decompensation, an RR was activated. All RR activations were analyzed for patient demographic characteristics, admitting and escalation diag-nosis, time spent by virtual team on the RR, and whether the RR resulted in transport to the ED or hospital read-mission. Results: Three hundred and twenty patients were admitted to ACH during the study interval; 230 received restorative care. Seventy-two patients (31.3%) had events that triggered an RR. Fifty (69.4%) of the RR events were related to the admission diagnosis (p < 0.001; 95% CI 0.59-0.80). Twelve patients (16.7%) required transport to an ED for further treatment and were readmitted and 60 patients (83.3%) were able to be treated successfully in the home by the RR team (p < 0.001; 95% CI 0.08-0.25).Conclusions: The use of an ACH RR team was effective at limiting both es-calations back to an ED and hospital readmissions, as 83% of deteriorating patients were successfully stabilized and man-aged in their homes. Implementing a hospital-at-home RR team can reduce the need for ED use by providing critical resources and carrying out required interventions to stabi-lize the patient's condition. (c) 2023 Elsevier Inc. All rights reserved.