The admission of patients with pneumonia directly from the Emergency Department to Hospital in the Home

Abstract

Introduction

Acute respiratory infection is often the commonest reason for patients to be admitted to hospital from the Emergency Department (ED). Hospital in the Home Units (HHUs) deliver acute hospital type care to patients at home. This study sought to review the safety and effectiveness of HHU care for patients with pneumonia referred directly from an ED to a HHU using standard selection criteria.

Method

A retrospective clinical audit of all patients with acute pneumonia referred from the ED to the HHU from March 2000 to March 2002.

Results

45 episodes in 44 patients were identified. 19 patients were female and the mean age was 53 years. Seven (15.6%) patients were residents of nursing homes.

In 23 (51.1%) episodes, patients had presented to ED already taking oral antibiotics for their current condition. In 30 patients, significant co-morbidities were identified.

The mean temperature on presentation was 37.7° Centigrade. The range of oxygen saturation was 89-100%, with a mean of 95%. Positive chest xray findings were reported in 41 (91.1%) of 45 episodes. In 9 (20%) cases an effusion was also reported.

Length of stay ranged from 1-20 days with a mean of 6.2 days. In all 45 episodes, patients were treated with ceftriaxone. Adjuvant oral therapy was initiated in 28 episodes. Other adjuvant therapy was initiated at admission: nebulised salbutamol (7); oral prednisolone (1).

Intravenous crystalloid fluids were required at home for rehydration in 2 episodes. Antibiotic therapy was altered in two cases. Oral prednisolone was commenced in 4 episodes, nebulised salbutamol commenced in 7 episodes, and fluconazole and frusemide were each commenced in a single episode.

In three cases the primary discharge diagnosis was not related to respiratory infection.

In 5 episodes (11.1%), patients made an unplanned telephone call to HHU staff. In 4 (8.9%) episodes, an unplanned staff visit was required. One patient required a return to hospital to complete her inpatient treatment. Two patients were readmitted within 1 month of discharge from EHHU.

Conclusion

Patients who present to EDs with respiratory infection requiring intravenous therapy may be safely referred directly into Hospital in the Home care.