Implementation of an innovative hospital at home program for patients with hematalogic malignancies Free

Introduction: Patients with aggressive hematologic malignancies have high rates of inpatient admissions. Specifically, patients receiving induction chemotherapy for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) experience prolonged hospital stays due to the length of induction, transfusion dependence, and high risk of neutropenic fever. Traditional early discharge programs (EDP's) have been previously implemented to transition these patients to an outpatient setting prior to count recovery, but they have not provided care at home, rather relying on outpatient services and hospital readmissions. We developed a novel single-institution Hospital at Home (HaH) program with in-home biometric vitals monitoring, transfusion support, and inpatient-level medical care for patients with hematologic malignancies, including those undergoing acute leukemia induction.

Methods: A HaH program was initiated at our tertiary academic cancer institute and safety-net hospital to allow early transition to a home environment with inpatient level services for patients with hematologic malignancies, including those receiving acute leukemia induction. Eligible patients were screened by inpatient Hematology, Hospital Medicine, and HaH teams; criteria for transition included absence of fever for 48 hours, less than daily blood transfusions, and a 24-hour caregiver. Residence distance within 45 minutes from the hospital was an initial criteria but was later waived as patients were able to transfer to an approved nearby hotel for ongoing care. Patients were monitored with a Biobeat biometric patch for continuous vitals monitoring (including blood pressure, heart rate, temperature, stroke volume, respiratory rate) that provided telemetry data in real time to the clinical team. Additionally, patients received at least twice daily visits by nursing staff, advance practice providers and/or physicians, which included phlebotomy, transfusion support, and IV infusions at home. We present data for 77 patients from 07/01/2024-06/30/2025 who were screened for the program.

Results: 77 patients were screened for HaH and 36 (46.8%) were successfully transitioned to HaH. Reasons for enrollment failure were distance (36.6%), insurance (31.7%), patient acuity (14.6%), patient/family preference (14.6%), or multiple (4.9%). Of the 36 enrolled patients, 15 (41.7%) had ALL, 8 (22.2%) non-Hodgkin lymphoma (NHL), 7 AML (19.4%), 2 (5.5%) myeloma, 2 (5.5%) blast-phase chronic myeloid leukemia, and 2 (5.5%) had other hematologic malignancies.

For the overall cohort, in-hospital length of stay (LOS) was 546 days, median inpatient LOS was 11 days (1-59), and median days enrolled in HaH was 5 (1-11). 183 inpatient bed-days were saved by HaH utilization (median 5 days per patient). Seven (19.4%) patients received platelet transfusions at home. Three (8.3%) patients were transferred to an approved hotel due to home distance outside the prespecified range. There were six (16.7%) unplanned readmissions, one for each of the following reasons: neutropenic fever (NF), cytokine release syndrome, hypoxia, abdominal pain, severe hypokalemia, and progressive leukemia. Thirty-day mortality was 0%.

In the acute leukemia subgroup (n=24), in-hospital LOS was 409 days, median inpatient LOS was 16 days (1-59), and median days enrolled in HaH was 6 (1-11). 142 inpatient-bed days were saved by HaH utilization (median 6 days per patient). Four (16.7%) acute leukemia patients had unplanned readmissions, including one each for NF, hypoxia, severe hypokalemia, and progressive leukemia.

Conclusions: This novel HaH program successfully provided inpatient-level care at home for patients with hematologic malignancies, including those undergoing acute leukemia induction. Continuous vitals monitoring devices were feasible and provided an additional measure of safety monitoring. Readmission rates were lower than those reported in other EDPs, and 30-day mortality was zero. Ongoing assessments will be conducted to identify additional eligible patients, determine rates of nosocomial infections at home, and improve access to inpatient-level care at home. This pilot project demonstrates a proof-of-concept for the safe delivery of high-level care for patients with hematologic malignancies, including acute leukemia induction, at home to improve bed capacity and allow increased access to care.