1. HOSPITAL AT HOME ANETTE TANDERUP MD, PH.D.-STUDENT Denmark, Odense University Hospital, Department of Geriatric medicine

2. Hospital at Home Supervisors:  Jesper Ryg, MD, Ph. D., Post doc.  Annmarie Touborg Lassen, MD, Ph.D., Professor, Head of Research Unit of Emergency Medicine.  Anne Lee, Executive Officer, MSc (Health), RN  Jens-Ulrik Rosholm: MD, Ph.D. Clinical associate professor.

3. Hospital at Home Collaboration:  Odense Municipality  Department of Emergency Medicine Odense University Hospital  Department of Health Science and Technology, Aalborg University  Centre for Applied Health Services Research  Systematic  Anygroup  Lindpro

4. Hospital at Home Funding:  University of Southern Denmark  Research Foundation of Odense University Hospital  Patient@home  The Velux Foundation No competing interests exist

5. Introduction:  In the future there will be an increasing number of acutely ill geriatric patients. There is some evidence that being treated in your own home instead of being admitted to the hospital is beneficial for some geriatric patients Hospital at Home Caplan Age and Ageing 2006 Zisberg J Am Geriatr Soc 2011 Leff Ann Intern Med 2005 Leff J Am Geriatr Soc 2009

6. Hospital at Home Objectives:  Feasibility of “Hospital at Home” (HH) supported by telemedicine

7. Hospital at Home Method:  Within the first 24 hours after admittance to the medical emergency department (MED) geriatric patients are assessed for their appropriateness and willingness to continue the admission in their own home

8. Hospital at Home ≥ 65 years Admitted to the MED Not resident in the municipality of Odense Living in nursing home Not a geriatric patient Not in need of at least 48 H additional admission Terminal patients Isolated patients Difficulty speaking or understanding Danish Participants in another research project In need of treatment or care that is not possible in this HH set-up (see table) Patients with severe cognition decline (acute or permanent) Patients not suitable for HH after assessment by doctor, nurse, and physiotherapist Patient or patients spouse do not wish to participate Patients suitable for HH

9. Hospital at Home HH Set-up:  Nurses from the municipality perform daily care, security checks and triage  Geriatric doctor and nurse do “ward round” daily  Physiotherapist will attend when needed  The patients can be transferred back to the hospital 24/7 in case of deterioration, technical breakdown etc.

10. Hospital at Home MeasurementMaximum frequency Blood sampleOnce a day ECGOnce a day Vital signs ( BP, RF, HR, Sat, Temp, GCS) Triage Every 3th hour DiuresisEvery 3th hour Treatment Restrictions Oxygen Maximum 2L Only via nasal cannula Fluid therapy Subcutaneous fluid Only isotonic Maximum 2L pr. day Nutrition Meal scheme Supplemental nutrition drinks Medicin Per oral Subcutaneous injections Intramuscular injections I v antibiotics Blood transfusion Only erythrocytes

11. Hospital at Home Technical set-up:  Telemedicine is used for safety and communication. An alarm is automatically generated by smoke/fire, falls, “leaving” the house, deterioration in vital signs, and unusual movement pattern at night. Patients, relatives, and personal can also activate the alarm.  Alarms go to a call-center nurse who can contact the patient by a call-system where communication and visual inspection is possible. The right help can thus be provided

12. Hospital at Home Patient home Hospital Call center Geriatric nurse Geriatric doctor Alarm ?

13. Hospital at Home Results:  Inclusion is still running and the results are not yet analyzed. The acceptability, practicality, implementation, and demand for HH will be addressed

14. Hospital at Home Data:  Data will be analyzed with the MAST-model K. K. The MAST manual 2010. Available from: http://www.mast-model.info/

15. Hospital at Home Safety:  Steering committee  Safety committee  Approval from ethical committee  Approval from the Danish Data Protection Agency

16. Hospital at Home Ethic considerations  Technology must not replace warm hands!  ”You do not se the elderly, when they are ”set free” by welfaretechnology that removes human contact”.  ”Technology can survey, but only humans can watch”. Birkler J, Politiken 090215

17. Hospital at Home Thank you For further information Anette.tanderup@rsyd.dk