In this prospective feasibility study, we found that a Hospital-at-Home (HaH) program for non-operative management of acute complicated diverticulitis (ACD) was both feasible and effective in a carefully selected patient population. Our results demonstrated an 80% success rate, exceeding our predefined feasibility threshold of 60%, with a median HaH length of stay (LOS) of 9.5 days. Importantly, the implementation of this program resulted in 98 saved in-hospital bed-days, a significant reduction in resource utilization. These findings support the notion that HaH could be a viable alternative to traditional inpatient care for selected patients with ACD, particularly in an era where hospital bed availability remains a critical issue.

The study demonstrated that HaH could be successfully implemented for ACD patients, with the majority (80%) completing their care without requiring unplanned healthcare visits. This aligns with previously reported success rates of HaH programs for other surgical conditions such as perforated appendicitis and same-day discharge colectomy, which range from 57 to 70%. Our findings suggest that, when appropriately triaged, patients with ACD can be safely managed at home with remote monitoring and virtual physician oversight.

Of the 10 patients enrolled, two required escalation of care: one for failure of disease resolution and another for anaphylaxis to antibiotics. These instances highlight the importance of careful patient selection and ongoing monitoring, as well as the need for clear escalation pathways. Notably, our study identified that 20% of participants ultimately required semi-elective surgery, suggesting that HaH may serve as a bridge to definitive intervention in select cases rather than a complete alternative to inpatient management. This was not determined a failure of the HaH program as they were scheduled for surgery and listed on the emergency list but remained home for the preoperative optimization period within the HaH virtual ward.

Traditional inpatient care for ACD involves prolonged hospital stays, primarily for administration of intravenous antibiotics and observation rather than active procedural intervention. Our study found that a substantial portion of hospital days in traditional care models are “idle-bed days,” where patients are stable but remain hospitalized. By shifting these patients to HaH, we effectively reallocated hospital resources without compromising patient safety or outcomes. The ability to conduct outpatient percutaneous drainage further supported the feasibility of HaH, as only one patient required this intervention during the study period. The potential benefits of HaH extend beyond individual patient care to broader healthcare system efficiencies. Given the increasing burden of diverticular disease on healthcare systems, HaH could serve as a strategy to optimize hospital resource utilization, particularly during periods of high demand, such as the COVID-19 pandemic. Our study’s findings suggest that even a small-scale HaH program can lead to meaningful hospital bed savings, supporting its expansion for ACD and potentially other non-operative surgical conditions.

However, challenges remain, including the need for robust home monitoring infrastructure, patient and caregiver education, and adequate staffing for remote clinical oversight. A comprehensive cost-effectiveness analysis should be conducted to ensure that the financial benefits of reducing hospital admissions are not offset by increased out-of-pocket expenses for patients, thereby shifting the economic burden rather than reducing overall healthcare costs.

Despite its promising findings, our study has limitations. The sample size was small (n = 10), limiting the generalizability of results. Additionally, selection bias may have influenced outcomes, as only carefully screened and consented patients were included. While this was necessary to ensure patient safety, it may not fully reflect the broader ACD patient population. Another limitation was the relatively short follow-up period, as outcomes beyond 60 days were not assessed. Future studies with larger cohorts and extended follow-up will be necessary to confirm long-term safety and efficacy, as well as evaluate patient and provider satisfaction to determine the acceptability and implementation of this model of care.