Home Sweet Home: Our Experience Providing Immediate Post-Transplant Care to Patients in Their Home

Hematopoietic stem cell transplantation (HSCT) is a rapidly evolving science.  Care of the patient undergoing any type of HSCT requires the transdisciplinary team to continuously evaluate the needs of the patient and family utilizing new evidence and best practice.  Within our Division we have implemented a protocol that allows for patients undergoing HSCT to receive their immediate post-transplant care during their pancytopenic phase of recovery at home provided they live within a 90 minute drive of our clinic. Our first participant received Zevalin® and BEAM chemotherapy followed by autologous stem cell rescue for DLBCL and was discharged home following stem cell reinfusion.  Daily visits in the home were initiated on day +1 and continued through day + 22.  During that time the participant required one overnight admission to our inpatient unit for management of febrile neutropenia, and two visits to our outpatient daily clinic due to unavoidable operational barriers to providing care in the home.  There were 17 midlevel provider visits which lasted between 30-90 minutes and 14 RN visits lasting between 2 and 4 hours.  Antibiotic infusions (# of days=11), electrolyte supplementation (# of days=12), intravenous hydration (# of days=4), blood transfusions (# of PRBC=2, # of platelet=7), filgrastim (# of inj=9) and documentation were all completed in the participant’s home by the nurse using internet based technology.  Participants used an internet based audio visual communication tool to communicate daily with the attending physician and all other ancillary services.  It is our hypothesis that fewer gastrointestinal and infectious complications will be observed, there will be a decrease in the cost of the procedure, and participants being treated in their home will report both higher functional and subjective QOL scores over the course of treatment when compared to the a control population.  Successful continued execution of this model will require partnership with managed care organizations, institutional transfusion, IT, and pharmacy services as well as the development of a staffing model to support this innovative method of care delivery for the unique HSCT population.