Levine et al listed criteria for selecting an acutely ill patient for hospital-level care at home. A key element for success is proper patient selection. The authors are from Brigham and Women's Hospital, Harvard Medical School and Massachusetts General Hospital.
Contraindications for hospital care at home:
(1) age < 18 years (may be suitable if program set-up by a children's hospital)
(2) patient declined, OR unable to give consent and no representative
(3) caregiver or family declined
(4) physician declined
(5) remote to catchment area
(6) condition not approved for home care
(7) residence in a long-term care or rehabilitation facility
(8) requires routine administration of controlled substances
(9) unable to independently reach bedside commode
(10) high risk for clinical deterioration
(11) homeless
(12) inadequate utilities (no working heat in winter' no air conditioning in summer; no water)
(13) in police custody
(14) screen for domestic violence positive
(15) unable to establish peripheral vascular access in the ED (if parenteral drug required)
(16) acute delirium
(17) need for in-hospital diagnostic testing or surgery
(18) infection with qSOFA > 1
(19) requires high-risk medication (IV insulin, other)
(20) multiple organ failures
