Module 0 - Introduction
In this module, you will be introduced to the structure and purpose of the e-learning programme. You will also meet the patient cases that will follow you throughout the course. Through these cases, you will explore clinical complexity, the home context, support needs, and digital capacity in Hospital at Home.
Welcome to an e-learning programme on Hospital at Home!
Introduction
Healthcare systems are undergoing significant transformation. The population is ageing, while the proportion of people of working age is declining. As a result, fewer healthcare professionals must care for an increasing number of patients. This demographic shift creates an urgent need for new and sustainable ways of organising healthcare delivery, and Hospital at Home (HaH) is one model of care that may help meet future healthcare needs.
This programme provides a comprehensive introduction to HaH—a model of care in which patients receive hospital-level treatment in their own homes.
The programme consists of four modules. Its overall aim is to support you in exploring the concept and developing an understanding of the knowledge, skills, and competencies required when working in Hospital at Home.
The programme is a result of the NorDigHE-project https://www.nordighe.org/
Meet the patients
This chapter presents the four patient cases that will be used throughout the e-learning programme. Alex, Stina, Hamid, and Alice represent different clinical conditions, life situations, levels of support, and digital capacities. Together, the cases illustrate how Hospital at Home requires individual assessment, clinical judgement, coordination, and adaptation to the patient’s home environment.
Case 1: Alex
Name: Alex
Age: 30
Living situation: Lives in a 3-room apartment with partner and dog (elevator available)
Occupation: Web designer, works from home
Social context: Strong partner support, independent in daily life.
Medical history
Crohn’s disease (diagnosed 5 years ago)
No other significant comorbidities
Current treatment
Adalimumab 40 mg every other week
Mesalazine (maintenance therapy)
Current presentation
Increased abdominal pain
Diarrhoea up to 8 times/day
Blood in stool
Fever (~38.0°C)
Fatigue and reduced energy
Reduced oral intake, mild weight loss
Clinical assessment (baseline)
General condition: Tired but alert
Temp: 38.1°C
HR: 98 bpm
BP: 118/72 mmHg
RR: 20/min
SpO₂: 98%
Abdomen: Diffuse tenderness
Lab: CRP elevated, mild anaemia
Functional status
Independent in ADL
Reduced work capacity during flare
Home environment
Stable, safe environment
Good hygiene conditions
Space for equipment
Digital capacity
High digital literacy
Uses smartwatch and symptom tracking app
Comfortable with video consultations
Initial assessment for HaH
Likely moderate flare of Crohn’s disease.
Suitable for:
IV corticosteroids
Fluid therapy
Remote monitoring
Case 2: Stina
Name: Stina
Age: 85
Living situation: Lives with husband in a townhouse
Social context: Husband is primary support, home care twice daily
Medical history
Heart failure (HFmrEF)
Hypertension
Type 2 diabetes
Current treatment
Oral antidiabetics
Heart failure medication (e.g. ACE inhibitor, diuretics)
Compression stockings
Current presentation
Urinary symptoms for 1 week
Antibiotic treatment switched (Selexid → Ciprofloxacin)
Fever
Increasing leg swelling
Fall at home with pelvic pain
Clinical assessment (baseline)
Temp: 38.6°C
BP: 129/76 mmHg
HR: ~100 bpm
RR: 26/min
SpO₂: 91% (94% sitting)
General condition: Tired, dyspnoeic on conversation
Heart: Regular rhythm
Lungs: Bilateral basal crackles
Abdomen: Tender, right-sided flank pain
Extremities: Severe bilateral oedema
Musculoskeletal: Pelvic tenderness
Functional status
Previously mobile with support
Now significantly reduced mobility
Increased dependency
Home environment
Adapted home
Husband present but strained
Home care support limited
Digital capacity
Low digital literacy
Dependent on staff for monitoring
Initial assessment for HaH
Suspected:
Pyelonephritis
Heart failure exacerbation
Possible pelvic fracture
Potential HaH care:
IV antibiotics
IV diuretics
Pain management
BUT: high risk patient
Case 3: Hamid
Name: Hamid
Age: 78
Living situation: Lives alone in apartment
Support: Home care services
Medical history
Chronic heart failure
Hypertension
Reduced mobility
Current treatment
Diuretics
Compression stockings
Regular monitoring via HaH
Current presentation
Gradual worsening mobility
Increasing leg swelling
Difficulty managing daily activities
Clinical assessment (baseline)
Vital parameters within acceptable range
No acute distress
Functional status
Uses walker
Dependent on routines and support
Home environment
Lives alone
Limited informal support
Digital capacity
Moderate/low
Relies on staff contact
Current situation
Routine follow-up delayed leading to contact occurs later than planned.
Case 4: Alice
Name: Alice
Age: 6 months
Living situation: Third child in a family living in an apartment, with two older siblings attending preschool.
Support: The family has limited access to practical support and both parents are currently on sick leave to manage the situation.
Case 4: Alice
Medical history
Previously healthy
Breastfed and bottle-fed
Current treatment
Intravenous antibiotics for confirmed meningitis
Central venous access
Planned total treatment duration: 20 days
Weekly blood tests
Current presentation
Initially admitted with high fever
Irritable and unsettled
Tachycardia
Elevated CRP
Clinical assessment (baseline)
Temperature: 39.8°C
Heart rate: 200 bpm
SpO₂: 98%
CRP: 140
Clinically affected but stabilised after initial hospital treatment
Functional status
Fully dependent on parents
Feeding requires close observation
Behaviour, crying, sleep, and responsiveness are important clinical signs
Home environment
Lives in an apartment with parents and two older siblings
Limited practical support
Requires safe storage of medication and equipment
Digital capacity
Parents can use phone or digital contact with the care team
Digital communication supports coordination
In-person assessment remains essential due to young age and serious infection
Current situation
Alice is discharged from hospital to continue intravenous antibiotic treatment at home three times daily, supported by advanced paediatric home care and municipal home healthcare.
References and further reading
This chapter presents the key references and resources on which the course is based. The list includes scientific articles, reports, guidelines, websites, and other materials that have informed the content of the modules. These resources can also be used for further reading by those who wish to explore Hospital at Home in more depth.
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