344 - A US Pilot Pediatric Hospital at Home: The Screening Cascade for a Pediatric Hospital at Home Unit

Publication Number: 4337.344

Tonya K. Obita, Levine Children's Hospital, Mint Hill, NC, United States; Stefanie Reed, Levine Children's Hospital, Charlotte, NC, United States; Sara Horstmann, Levine Children's Hospital, Cornelius, NC, United States; Douglas A. Dodds, Levine Children's Hospital, Cornelius, NC, United States; David Marseille, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Charlotte, NC, United States; Dustin Long, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston-Salem, NC, United States; Gang Liu, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Charlotte, NC, United States; Christine B. Turley, Atrium Health Levine Childrens, Wake Forest University SOM, Charlotte, NC, United States

Background: During the COVID-19 pandemic, our institution successfully used an adult hospital at home (AHaH) program to expand capacity. Our Pediatric Hospital Medicine (PHM) department faced a similar capacity challenge, spending 90% of 2024 at or exceeding capacity. While pediatric acute hospital at home (PAH@H) is used internationally for some acute care, US health systems had not integrated this model into inpatient pediatric medicine. In February 2025, our PHM department launched a PAH@H program, focused on building and evaluating a model of providing acute hospital level care directly in a patient's home.

Objective: We hypothesized that implementation of PAH@H can be a meaningful option for acute care patients through careful medical and environmental screening. This report summarizes the screening characteristics of patients in the first seven months of the pilot phase.

Design/Methods: A rapid medical screening questionnaire was developed for use in all PHM patients, followed by an environmental interview assessment for those meeting initial medical stability criteria (table 1). Invitation for transfer to PAH@H and participation in the research survey occurred if all criteria were met for these two steps. Local IRB approval was obtained prior to initiation of the program.

Results: In the first 7 months of our pilot phase, 1942 patients were medically screened; 154 patients screened medically stable and were interviewed (Figure 1). After the interview 149 patients qualified for program entry. 121 patients agreed to enroll and 118 received care in the unit. The reasons for declination are listed in table 2.

Conclusion(s): A robust screening process for a PAH@H program can be implemented efficiently and used to identify and admit patients to this novel model of pediatric care. Medical screening and environmental assessment were important to ensure clinical and environmental stability for the program. In the first 7 months, the majority of families offered this model chose to enroll.

Table 1: Program Eligibility Criteria


Figure 1: Pediatric Hospital at Home Screening Cascade
LCH: Levine Children's Hospital, NC: North Carolina, BaM: Brick and Mortar


Table 2: Reasons Families Declined the Program Reason* N (%)
Families could choose more than one reason