Hospital at Home and Emergence of the Home Hospitalist

M s. P., an 86-year-old woman with a history of hypertension, hyperlipidemia, coronary artery disease, and transient ischemic attack, presents to the emergency department with a three-day history of cough, fever, purulent sputum, fatigue, and dyspnea on exertion. Her vital signs are notable for a fever of 39.0°C, blood pressure 136/92, pulse 102, respiratory rate 30, and room air oxygen saturation of 91%. She looks ill. She has a white blood cell count of 16,000, lactate 1.9, and a right lower lobe infiltrate on imaging. The emergency department attending physician presents the case to you for admission, and you accept the patient into your inpatient hospitalist service. Now, let’s imagine a different future in which you are the attending hospitalist on your institution’s Hospital at Home (HaH) service, where you will provide hospital-level care to Ms. P. in the comfort of her own home. Hospitalists should prepare for this paradigm shift.