Small Bowel Obstruction Conservatively Managed in Hospital-At-Home

Area of Science:

• Medical Technology
• Virtual Care
• Surgical Care

Background:

• Mayo Clinic launched an Advanced Care at Home (ACH) program in 2020, integrating telemedicine with in-home services.
• The ACH program utilizes a software-driven, vendor-mediated medical supply chain for comprehensive patient management.
• Initially focused on acute medical diagnoses, the program now extends to surgical and postsurgical patients requiring ongoing inpatient care.

Observation:

• A 52-year-old female presented with symptoms of a mechanical small bowel obstruction (SBO), confirmed via CT scan.
• The patient received initial conservative treatment, including nasogastric (NG) tube placement and IV fluid resuscitation, in the hospital ward.
• She was subsequently transferred to the ACH program for continued NG suctioning, IV therapy, and daily virtual monitoring.

Findings:

• The patient successfully received acute care at home for 5 days, including invasive treatments like NG tube suctioning.
• Daily virtual visits and twice-daily in-person assessments by a nurse and paramedic ensured continuous monitoring and medication administration.
• Following the acute phase, she transitioned to a 10-day remote restorative monitoring phase, achieving full recovery.

Implications:

• This case demonstrates the feasibility of managing high-acuity conditions like small bowel obstruction within a hospital-at-home (HaH) framework.
• Virtual hybrid programs can effectively deliver invasive treatments and monitor for clinical decompensation, improving patient care accessibility.
• The integration of virtual care with a robust in-home supply chain offers a scalable model for advanced home-based medical services.