Implementation of Sweden's first digi-physical hospital-at-home care model for high-acuity patients

Aim: To evaluate Sweden's first implementation of a 24/7 high-acuity virtual in-patient ward through a digi-physical in-patient care (DPIPC) program, a hospital-at-home care model combining a virtual hospital-based medical command centre and in-person ambulating medical services functioning as an extension of the Department of Medicine at a secondary-level hospital in Stockholm.

Methods: A single-centre descriptive study where adult patients with acute medical illness requiring inpatient-level care were assessed for voluntary treatment in the DPIPC program as a substitute for traditional in-patient care. The primary outcome was patient satisfaction with care. Secondary outcomes included health care use, safety, and quality during the care episode.

Results: From October 2022 to June 2023 a total of 200 patients were treated within the DPIPC program. The program covered 63 unique medical conditions, with infectious disease (44%) and pulmonary disease (17%) being the most common. The median length of stay (LOS) in the DPIPC program was 3 days (IQR 3) with a median LOS of 2 days (IQR 3) in the physical hospital prior to inclusion. There were no incidents of patient mortality or hospital-related complications during the DPIPC period. A total of 11 (5.5%) patients were escalated to the traditional hospital, 4 (36.4%) of which required ambulance. The median DPIPC patient satisfaction was 10 (IQR 0) and Net Promotor Score was 88.

Conclusions: Implementing a 24/7 high-acuity virtual in-patient ward is feasible and safe for selected patients with acute medical illnesses. Patient satisfaction and care quality within the program is high.