Implementation of a hospital-at-home (HAH) unit for hematological patients during the COVID-19 pandemic: safety and feasibility

Int J Hematol. 2022 Jan;115(1):61-68. doi: 10.1007/s12185-021-03219-2. Epub 2021 Sep 22.

Abstract

Background: "Hospital-at-home" (HAH) programs have been shown to optimize resource utilization, shorten hospitalization and prevent nosocomial infection.

Methods: We retrospectively analysed data regarding implementation of an HAH unit for caring patients with hematological malignancies in our center, during the COVID-19 pandemic.

Results: Between January and November 2020, 105 patients were treated in the HAH unit for a total of 204 episodes. Nine patients with multiple myeloma (MM) received autologous HSCT (auto-HSCT). Three patients with acute myeloid leukemia (AML) received consolidation therapy, 32 patients underwent clinical and analytical monitoring, 20 were transplant recipients early discharged (5 auto-HSCT and 15 allo-HSCT) and 2 had received CART cells therapy. Azacitidine, bortezomib and carfilzomib were administered at home to 54 patients with AML, myelodysplastic syndrome (MDS) or MM. A median of 17 (IQR 13-19) days of admission per patient and a total of 239 visits to the Hematology day-care hospital were avoided. Overall, 28 patients (14% of all episodes) needed admission to the hospital, 4 of them due to COVID-19.

Conclusions: Implementation of a Hematology HAH unit was feasible and safe, and provided thorough advanced care to a high-risk population. Advanced care-at-home strategies can be crucial during times of COVID-19 to minimize treatment interruptions and reduce the risk of cross-infections.

Keywords: COVID-19; Hematology; Hospital-at-home; QOL.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19* / epidemiology
  • Continuity of Patient Care*
  • Disease Management
  • Feasibility Studies
  • Female
  • Hematologic Neoplasms / therapy*
  • Hematopoietic Stem Cell Transplantation
  • Hospitalization
  • Humans
  • Leukemia, Myeloid, Acute / therapy
  • Male
  • Middle Aged
  • Multiple Myeloma / therapy
  • Myelodysplastic Syndromes / therapy
  • Retrospective Studies
  • Transplantation, Autologous
  • Young Adult