Remote Physician Care for Home Hospital Patients

Exclusion Criteria

• •Undomiciled
• •No working heat (October-April), no working air conditioning if forecast \> 80°F (June-September), or no running water
• •On methadone requiring daily pickup of medication
• •In police custody
• •Resides in facility that provides on-site medical care (e.g., skilled nursing facility)
• •Domestic violence screen positive
• •Acute delirium, as determined by the Confusion Assessment Method2
• •Cannot establish peripheral access in emergency department (or access requires ultrasound guidance, unless point-of-care ultrasound is available)
• •Secondary condition: end-stage renal disease on hemodialysis, acute myocardial infarction, acute cerebral vascular accident, acute hemorrhage
• •Primary diagnosis requires multiple or routine administrations of intravenous narcotics for pain control
• •Cannot independently ambulate to bedside commode, unless home-based aides are available
• •As deemed by on-call MD, patient likely to require any of the following procedures: computed tomography, magnetic resonance imaging, endoscopic procedure, blood transfusion, cardiac stress test, or surgery
• •High risk for clinical deterioration
• •Home hospital census is full