Admission avoidance and early discharge hospital at home might release hospital beds for people with COVID-19
Citation: Shepperd S, Iliffe S, Doll HA, et al. Admission avoidance hospital at home. Cochrane Database of Systematic Reviews 2016; (9): CD007491
Citation: Gonçalves‐Bradley DC, Iliffe S, Doll HA, et al. Early discharge hospital at home. Cochrane Database of Systematic Reviews 2017; (6): CD000356
What is this? Services such as hospital at home provide an alternative to hospitalization, and can ease the demand for hospital beds. These schemes provide an admission avoidance or an early discharge function. Evidence to date cannot be directly applied to the population hospitalized for COVID-19, but can be used by health service planners seeking alternatives to hospitalization for some other populations, thereby releasing hospital beds for people with COVID-19.
In these two Cochrane systematic reviews, the authors searched for randomized trials of the effects of admission avoidance and early discharge hospital at home. The searches were completed in March 2016 for the admission avoidance review (16 studies included) and January 2017 for the early discharge review (32 studies included). The reviews are being updated and will include one large trial of admission avoidance hospital at home that has not yet been published.
What works: Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of elderly patients requiring hospital admission.
Early discharge hospital at home probably reduces hospital length of stay in people who are recovering from a stroke.
Early discharge hospital at home for older people with a mix of conditions that required hospitalization may reduce hospital length of stay.
Early discharge hospital at home following surgery (most trials recruited people recovering from orthopedic surgery) reduces hospital length of stay.
What doesn’t work: Nothing noted.
What’s uncertain: The effects of admission avoidance hospital at home on cost to the health services are uncertain.
The effects of early discharge hospital at home on health outcomes, readmission to hospital and cost are uncertain.
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