Status:
COMPLETED
A Hospital-at-Home Pilot in Singapore
Lead Sponsor:
National University Health System, Singapore
Collaborating Sponsors:
National University of Singapore
Conditions:
Hospital-at-home
Eligibility:
All Genders
21+ years
Brief Summary
Hospital-at-home models seek to address the impending shortage of hospital beds by reimagining the way we deliver acute hospital-level care - substituting the ward for a patient's home. Such programme...
Detailed Description
1. Hypothesis We hypothesise that hospital-at-home programmes may reduce cost of delivering care with comparable clinical outcomes (readmissions, mortality, and hospital-acquired complications) an...
Eligibility Criteria
Inclusion
- Admitted to one of the following wards:
- Episodic short stay patients
- NUH Extended Diagnosis and Treatment Unit (EDTU)
- AH Extended Diagnosis and Treatment Unit (EDTU)
- NUH Acute Medical Unit (AMU)
- Long stay patients requiring ongoing treatment or monitoring
- NUH general medicine wards
- AH general medicine wards
- Speciality specific treatment and monitoring with a protocolised approach
- Fluid overload admissions from NUH cardiology service
- Fluid overload admissions from NUH nephrology service
- ≥ 21 years old
- Lives within the Western Cluster of Singapore (pre-specified list of postcodes)
- Requires continued hospitalisation
- The EDTU is a ward within the emergency department that patients can stay for up to 24hours for diagnosis and treatment and meant for discharge after. Some of these patients subsequently require hospital admission, which would be the target group for the pilot. The AMU is a short-stay ward at NUH which aims to discharge patients within 72 hours of stay.
Exclusion
- Lives in nursing home
- Suitable for discharge to other community programmes
- Planned for discharge the next day (D-1)
- Haemodynamic instability defined as NEWScore \>2 at time of recruitment (a NEWScore ≤2 in a local setting showed very low rates of transfer to intensive care and death in 24 hours )
- Requires oxygen (long term oxygen therapy is acceptable)
- Acute psychosis or suicidal intent
- Need for negative pressure isolation
- Anticipated to deteriorate
- Planned for imaging, endoscopy, blood transfusion, cardiac stress test, surgery, interventional radiology procedures or ongoing non-medical specialist review
- Need for intravenous controlled drugs (e.g. morphine)
- Unable to establish venous access in emergency department
- Current or former intravenous drug user
- History of violence towards healthcare workers
- Cannot provide meals at home
- Does not have a bed, table and fridge at home
- Patient or caregiver unable to use a phone
- House is unsuitable for home visits and medical equipment
- Unable to be homebound independent, or have a full-time caregiver to assist with daily activities if not homebound independent
- Caregivers unable or unwilling to manage patient's care at home
- Projected to require more than 2 weeks of rehab
- For fluid overload cases, acute myocardial infarction within 5 days
- Pregnant
- Anticipated to require sliding scale insulin more than twice a day, where patient and/or caregiver are not able to measure BSL or administer insulin doses at home independently
- Unable to understand simple instructions for oral self-administration of medication
Key Trial Info
Start Date :
January 18 2021
Trial Type :
OBSERVATIONAL
Allocation :
ACTUAL
End Date :
June 18 2023
Estimated Enrollment :
378 Patients enrolled
Trial Details
Trial ID
NCT04330378
Start Date
January 18 2021
End Date
June 18 2023
Last Update
January 9 2024
Active Locations (2)
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1
Alexandra Hospital
Singapore, Singapore
2
National University Hospital
Singapore, Singapore