Integration of Acute Huntsman at Home™ into Emergency Care: A Systematic Implementation Plan

Home hospital is a home-based care model that delivers hospital-level services seen in an inpatient hospital setting. This care model has been used in several developed countries (i.e. Spain and Australia) with prior studies indicating that it may reduce cost, maintain quality and safety, and improve patient experiences (Levine et al., 2019). Given its dedication in providing the highest quality standards, the Huntsman Cancer Institute (HCI) at the University of Utah Healthcare (UHealth) established the Huntsman at Home™ program in 2018. This innovative care program provides hospital-level care exclusively to cancer patients in their own home. It is well-known that cancer is an abnormal growth in cells that has the potential to spread into different parts of the body. Cancer patients have complex medical needs that must be addressed by a specialized team due to the complex medical issues that arise from the part of the body where the cancer is located. Like other patients that are seen at the emergency department (ED), cancer patients are medically assessed and treated during their medical crisis with options to be admitted into the hospital or discharged to home once their medical crisis is stabilized. Within the United States, it was reported that approximately 10% of emergency visits resulted in hospital admissions in 2017 (Rui & Kang). This growing concern of hospital admissions indicates that an alternative solution is needed. Huntsman at Home™ is a viable solution that has the potential revolutionize the standard acute hospital-based delivery model. In 2017, 40% of HCI Cancer Hospital admissions were due to cancer-related symptom management issues, which could have been avoided with the Huntsman at Home™ program (Beck, 2018). The aims of Huntsman at Home™ are (Titchener et al., 2020): -Provide value to the health system, patient, and family caregivers -Provide hospital-level care in patient's own home -Improve symptom management and quality of life -Reduce hospital length of stay, ED visits, and hospital readmissions -Provide less invasive care at end of life These aims convey the capability of Huntsman at Home™ to be integrated into the ED, which will expand the current referral system to include acute care services. The aim of this systematic implementation plan is to seamlessly integrate Huntsman at Home™ into the UHealth ED workflow to reduce hospital-based admissions, reduce ED visits, and provide a home-based option for cancer patients to receive standard acute hospital-level services. The goal of this project is to develop new processes for initiating the delivery of home-based acute hospital-level services for cancer patients so that hospital-based admissions and repetitive ED visits may be reduced. Specifically, this will be accomplished if the following targets are met: Reduce hospital-based admission rates by 10% among patients participating in the Acute Huntsman at Home™ program for 12 months following ‘ go live' date -Reduce emergency room visit rates by 5% among patients participating in the Acute Huntsman at Home™ program for 12 months following ‘go-live' date. Specific Objectives: To properly integrate Huntsman at Home™ with the UHealth ED, this project recommends that Huntsman at Home™ create a branched program called Acute Huntsman at Home™ to allow separation of patients receiving hospital-level services and acute hospital-level services. Prior to the launch of the program, the following objectives must be met and are the focus of the work reported in this paper: to establish a) a project management and implementation plan, b) the criteria and processes for admitting patients from the ED into the Acute Huntsman at Home™ program, c) the policies that will guide communication and care standards while patients are managed in the program, and d) the evaluation metrics to assess whether the stated goals are met.