Abstract
Background: The UK healthcare system faces challenges due to an ageing population and chronic bed shortages. An acute hospital-at-home (HaH) model of care can offer an alternative for acutely ill patients requiring hospital admission. However, monitoring thesepatients at home presents its own challenges. We used the National Early Warning Score (NEWS) for patients admitted to a HaH to identify deteriorating patients and ensure safe and timely transfer back to hospital when needed. Design: Retrospective observational cohort study of patients with selected medical conditions admitted to acute HaH, from an NHS district hospital, between 2014 and 2017. Results: Of the 502 patients admitted to HaH, 443 (88.2%) were successfully treated and discharged, 1 patient died at HaH (an expected death), and 58 (11.5%) required transfer back to hospital and no fatalities reported after transfer. The AUC for total NEWS was significantly lower for non-transferred patients (14.06) compared to transferred patients (24.71) (p < 0.001). 95% of patients treated at HaH rated their care as excellent or good, and 98% were likely to recommend the service Conclusion: The study confirms the safe and effective use of the NEWS to identify deteriorating patients in an acute HaH setting, enabling timely transfer back and demonstrating that HaH care can be extended to acutely ill patients. This service could serve as an alternative healthcare system for clinically selected patients. It optimizes resource utilization, reduces the burden on acute medicine departments, and enhances patient experience.