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The “Hospital-at-Home”: Hospital-level Home Care for Bronchiolitis

September 6, 2022

Inpatient admissions of children with bronchiolitis are common. But are hospital stays really necessary for supplemental oxygen or nasogastric feedings versus providing these services at home? This concept of a hospital-at-home (HAH) has become popular for adult care and for pediatric care of children with chronic illnesses such as cancer and cystic fibrosis.

To evaluate this possibility, Lawrence et al (10.1542/peds.2022-056603) share with us a systematic review evaluating the feasibility, acceptability, safety, and cost-impact of creating a HAH young children with bronchiolitis. Ten relevant studies were included, all addressing home oxygen therapy (HOT). The authors found that the use of HOT was feasible in a home setting, that caregivers found it acceptable, and that adverse events were minimal with no deaths among 1,257 patients. Unfortunately, the review reveals little about the feasibility of HAH use for nasogastric feedings or whether the costs of doing this make sense relative to the costs of hospitalization. 

So is HAH treatment of moderate bronchiolitis for oxygenation or hydration the way to go? To answer that question, we invited Drs. Julia Freeman and Lalit Bajaj from the Section on Emergency Medicine at the University of Colorado (10.1542/peds.2022-058042) to share their thoughts about HOT rather than hospital oxygen therapy for bronchiolitis. They note the benefits as well as barriers of HOT but raise the issue of whether HOT with continuous home pulse oximetry monitoring would lead to more ED visits or even hospital e-admissions due to pulse oximetry findings. Drs. Freeman and Bajaj do see HAH programs useful in the setting of bed shortages or to replace observation units but note a number of unknowns such as whether nasogastric hydration can be successfully given at home on an acute care basis. HAH may be a HOT topic for you to consider so link to this article and commentary and learn more.

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