Care of patients with bacteremia in the setting of a telemedicine-controlled hospital-at-home service is effective and safe: A case-series of 28 patients

Hospital-at-home (HAH) is increasingly recognized as a viable alternative to in-hospital stay across various clinical settings. However, until recently, complex patients, particularly those with bacteremia, were not considered suitable candidates for HAH care. The purpose of this article is to describe a unique series of these high-risk patients and the means for attending them at home, for the first time in scientific literature. A retrospective analysis was conducted on a group of patients with bacteremia who were treated in the setting of a telemedicine-controlled HAH service. Twenty-eight patients with blood stream infections were treated in our HAH service. 60.7% were female, with a patient median age of 77 years. Most patients (64.3%) were admitted from the internal medicine ward; 17.86% (5 patients) were admitted at home, and 17.86% were admitted directly from the emergency department. A significant portion had severe comorbidities: 53.6% presented with malignancies, 21.4% presented with dementia, 42.9% presented with diabetes mellitus, 42.9% had chronic kidney disease, and 7 patients (25%) were on continuous immunosuppressive medication. The mean length of HAH stay was 4.1 ± 2.0 days. The majority (67.9%) were discharged at home, while 28.6% required transfer to in-hospital care. One patient died during the HAH stay, and another died during the 30-day follow-up. Telemedicine-controlled HAH service is a viable alternative to traditional in-hospital care for high-risk patients suffering from bacteremia. This is the first clinical report asserting that careful patient selection and meticulous management during HAH care result in good clinical outcomes.