Getting children home sooner on intravenous antibiotics with a Hospital-in-the-Home model of care for complicated appendicitis

•Children post severe complicated appendicitis remain in hospital on IV antibiotics•We developed clinical criteria for early safe completion of IV antibiotics at home•The piloted clinical pathway shortened inpatient stays by 35%•The model was safe, with no increase in complications or readmissions•All eligible patients treated at home would save AUD66,646 per year at our hospital Children with complicated appendicitis requiring prolonged intravenous antibiotics could complete their treatment under Hospital-in-the-Home (HITH). Evidence is lacking in identifying suitable patients. To determine the feasibility of using post-operative clinical criteria in complicated appendicitis to identify eligible patients, and assess the safety of treating HITH-suitable patients at home. This was a prospective pilot study at a tertiary pediatric hospital. Children aged 5-18 years, undergoing appendicectomy, identified as having complicated appendicitis intra-operatively, with at least 5 days’ post-operative intravenous antibiotics planned. HITH suitable patients were defined clinically as tolerating diet and passing flatus before day 5. The HITH model of care was developed and piloted. HITH-suitable patients were transferred and treated via HITH. Clinical characteristics and post-operative outcomes were measured and compared between patients treated in the hospital and patients treated at home. During the model development 83 patients fulfilled inclusion criteria: 35 (42%) HITH-suitable and 48 (58%) HITH-unsuitable. The groups were similar pre-/peri-operatively, but post-operatively HITH-suitable patients recovered faster (median length of stay 6 versus 7 days, p