Connected care for endocarditis and heart failure patients: a hospital-at-home programme

Abstract

Background: Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country's gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) AIM: In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction.

Results: We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record.

Conclusion: The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

Keywords: Antibiotic treatment; Endocarditis; Heart failure; Hospital at home.

Fig. 1

Organisational hospital-at-home model of the Noordwest Ziekenhuisgroep and Omring. On the left, the Noordwest activities and devices are depicted; on the right are those of Omring. Noordwest develops home-to-hospital protocols with mobile laboratory services and hospital-to-home protocols with Omring. Omring provides care at home with technical care nurses and nurse practitioners

Fig. 2

C‑reactive protein (CRP) levels during admission and treatment at home. CRP levels of all endocarditis-at-home patients since hospital admission. Time = 0 Admission to the virtual ward for intravenous antibiotic treatment ‘endocarditis at home’