The virtual home hospital septic stone discharge pathway
Results following implementation at a single Canadian center
DOI:
https://doi.org/10.5489/cuaj.9749Keywords:
virtual care, septic stone, discharge pathwayAbstract
Introduction: Traditionally, patients with septic stones (SS) remain hospitalized until clinically stable and culture-directed oral antibiotic therapy can be initiated, leading to a prolonged hospital stay after source control. A novel virtual home hospital (VHH) pathway was introduced to enable early discharge with physician oversight, including lab work and home-based intravenous antibiotics pending rationalization. Our primary objective was to assess length of hospital stay (LOS). Secondary objectives included representation rates and other complications.
Methods: A total of 137 SS patients were retrospectively analyzed at the University of Alberta, of which 37 were enrolled in the VHH pathway. Collected data included demographics, clinical course details, blood culture results, admission timelines, and unplanned healthcare visits.
Results: No demographic differences were noted between groups. Intensive care unit admission occurred in more non-VHH patients compared to VHH patients (17% vs. 3%, p=0.03). Significantly more positive blood cultures were noted in the non-VHH group (49% vs. 24%, p=0.009). Mean LOS was significantly shorter in the VHH group (3.8 vs. 2.3 days, p=0.005). Mean antibiotic duration was shorter in the VHH group (12.3 vs. 10.2 days, p<0.001). No significant differences were observed for emergency or clinic representations (p=0.77, p=0.06).
Conclusions: Preliminary results suggest that a novel VHH pathway is a feasible and safe approach for managing SS patients. With implementation of the VHH pathway, there was a significantly shorter LOS and antibiotic duration, which may be secondary to closer outpatient followup and antibiotic rationalization. This has the potential to free up in-patient hospital resources in a resource-limited socialized healthcare system.
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