Scoping and testing rural acute care at home: a simulation analysis

Purpose Hospital-level care provided at home improves patient outcomes, yet nearly all programmes function in urban environments. It remains unknown whether rural home hospital care can be feasibly delivered. Methods Based on prior stakeholder learning and detailed landscape analyses of various rural areas across the country, we re-engineered the workflows, personnel and technology needed to respond to many of the challenges of delivering acute care in rural homes. We performed a preliminary `mock admission' in a simulation laboratory with actor feedback, followed by mock admissions in rural homes in Utah of chronically ill patients who feigned acute illness. We employed rapid cycle feedback from clinicians, patients and their caregivers and qualitative analysis of participant feedback. Findings Following rapid cycle feedback in the simulation laboratory and rural homes, mock admission, daily rounds and discharge were successfully conducted. Technology performed to laboratory-determined specifications but presented challenges. Patients noted significant comfort with and preference for rural home hospital care, while clinicians also preferred the model with the caveat that proper patient selection was paramount. Patients and clinicians perceived rural home hospital as safe. Clinicians noted rural home hospital workflows were feasible after streamlining remote and in-home roles. Conclusions Rural home hospital care is technically feasible, well-received and desired. It requires testing with acutely ill adults in rural settings.