Non-inpatient care settings may offer alternatives to inpatient beds for select patients

1. Non-inpatient settings, including ambulatory treatment centers, emergency department observation units, and advanced care at home programs, may offer alternatives to inpatient hospitalization for select patients.

2. Seven-day emergency department return visit rates were similar across all care settings, while observed 30-day mortality and hospitalization rates were lower among patients treated in non-inpatient settings than among hospitalized patients.

Evidence Rating Level: 2 (Good)

Study Rundown: As inpatient admission is costly and can result in adverse events, some hospitals have begun incorporating alternative non-inpatient spaces including ambulatory treatment centers (ATC), advanced care at home (ACAH) and emergency department observation units (EDOU). Sax et al. performed a retrospective cohort study of emergency department (ED) patients from 2024-2025. Data for over 26,000 ED encounters were collected both with respect to the care location (ATC, ACAH, EDOU, inpatient) and outcomes involving care escalation, return visits, and 30-day mortality and hospitalizations. 25.3% of patients received non-inpatient care. Overall, 7-day ED visit rates were similar across all groups. Observed 30-day mortality and hospitalization rates were lower in the non-inpatient groups compared to inpatient group. This study demonstrates that care venues outside of the inpatient setting may be beneficial for selected patients and lessen the burden on hospital resources. The study effectively compares outcomes across several settings within one hospital system with established alternatives to inpatient treatment. However, the lack of risk-adjusted outcomes and randomization limits comparisons between care settings, particularly since patients were selected for treatment based on their clinical characteristics.

Click here to read the study in JAMA

Relevant Reading: Evaluation of an Advanced Care at Home Pilot Program

In-Depth [retrospective cohort]: Sax et al. performed a retrospective cohort study conducted across multiple settings in the Kaiser Permanente Northern California Network from 2024-2025. Emergency department (ED) patients aged 19 years and older diagnosed with six acute conditions (heart failure, pneumonia, cellulitis, urinary tract infection, COVID-19, or anemia) with an active health plan were included. Exposure was determined as ED care with transition to ambulatory treatment center (ATC), advanced care at home (ACAH) program, emergency department observation unit (EDOU) or inpatient. Triaged location was determined by clinical team with shared decision making. Outcomes measured included escalation of care to inpatient from three non-inpatient settings, 7-day return ED visit, 30-day hospital admissions, and 30-day all-cause mortality. The study included 26,618 ED encounters with 25.3% of patients treated in a noninpatient setting (2.7% ATC, 3.3% ACAH, 19.3% EDOU). Patients with greater comorbidities, older age, and greater mobility restrictions were more likely to be inpatient. ATCs and ACAHs use differed by condition with more patients with heart failure in ATCs and more patients with UTIs and pneumonia in ACAHs. Inpatient admission rates for patients in ATCs or ACAHs were lower compared to those in EDOUs. Across all four venues, 7-day ED return visit rates were similar. Observed 30-day mortality and hospitalization rates were lower among patients treated in noninpatient settings than among hospitalized patients, although these comparisons were not risk-adjusted.

Citation: Sax DR, Mark DG, Huang J, Witkowski AE, Rao P, Sudhalkar HA, et al. Noninpatient Alternative Treatment Venues for Acute Care Needs. JAMA Netw Open. 2026 Nov 2;9(11):e2641859. doi: 10.1001/jamanetworkopen.2026.41859. PMID: 42975899.

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