At the American Society of Hematology meeting, presenters shared a novel “hospital at home” (HaH) program that provided inpatient-level care at home for patients with hematologic malignancies. Continuous vitals monitoring was feasible, intervention and readmission rates were low, and no deaths occurred.
“Patients with aggressive hematologic malignancies have high rates of inpatient admissions. Specifically, patients receiving induction chemotherapy for acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) experience prolonged hospital stays due to the length of induction, transfusion dependence, and high risk of neutropenic fever,” wrote the authors, led by Nikesh Shah of Tampa General Hospital Cancer Institute in Florida.
The authors explained that traditional early discharge programs have been used to transition such patients, but those transitions have focused on outpatient services and hospital readmissions. They aimed to assess a novel program that focuses on this level of care at home.
To be eligible, patients had to be screened by inpatient hematology hospital medicine, and the HaH team. They also had to have no fever for 48 hours, blood transfusions less frequently than daily, and the availability of a 24-hour caregiver at home. Initially, patients had to live within 45 minutes of the hospital, but that criterion was waived with use of a local hotel.
The HaH program included:
- In-home biometric vitals monitoring for blood pressure, heart rate, temperature, stroke volume, respiratory rate
- Telemetry data transmitted to the clinical team in real time
- At least twice daily visits by nursing staff, advance practice providers, and/or physicians
- Phlebotomy, transfusion support, and IV infusions at home
- Inpatient-level medical care for patients with hematologic malignancies, including those undergoing acute leukemia induction.
To assess the program’s effectiveness, the team assessed data on 77 patients who were screened for the program from July 2024 to June 2025. Of those, 36 (47%) were eligible and transitioned to home. Reasons patients were not enrolled included distance (37%), insurance (32%), patient acuity (15%), patient or family preference (15%), or multiple reasons (5%). Among those who enrolled, 15 (42%) had ALL, eight (22%) had non-Hodgkin lymphoma (NHL), seven had AML (19%), two (6%) had myeloma, two (6%) had blast-phase chronic myeloid leukemia, and two (5.5%) had other hematologic malignancies.
Comparatively, the hospitalized group had a median stay of 11 days, with a range of one to 59. Those in the HaH program were enrolled for a median five days, with a range of one to 11. According to the researchers’ calculations, this saved 183 inpatient bed-days. At-home interventions were platelet transfusions for seven (19.4%) patients, and six (17%) unplanned readmissions occurred for neutropenic fever, cytokine release syndrome, hypoxia, abdominal pain, severe hypokalemia, and progressive leukemia. Thirty-day mortality was 0%.
“This pilot project demonstrates a proof-of-concept for the safe delivery of high-level care for patients with hematologic malignancies … at home to improve bed capacity and allow increased access to care,” the authors concluded. “Ongoing assessments will be conducted to identify additional eligible patients, determine rates of nosocomial infections at home, and improve access to inpatient-level care at home.”
Reference
Shah N, Barris J, Mcintosh C, et al. Implementation of an innovative hospital at home program for patients with hematologic malignancies. Abstract 520. Presented at: the 67th American Society of Hematology Annual Meeting and Exposition, Dec. 6-9, 2025, Orlando, FL.
