How safe is hospital-in-the-home care?

Abstract

To describe the rate of negative, unexpected and adverse events associated with hospital-in-the-home (HIH) care in an established unit, and to validate indicators of safety for HIH care. Prospective descriptive survey. 231 patients, who would otherwise have required hospitalisation, accepted for acute home-based care by the HIH unit at Frankston Hospital, a 350-bed hospital serving a population of 240,000 on the south-eastern boundary of Melbourne. The following indicators of safety: patient telephone calls to the on-call service; unscheduled staff callout to patients' homes; return to hospital during an HIH admission; and return to hospital after discharge. 190 acute admissions were examined. Planned same-day admissions were uneventful and excluded from the analysis. The therapies provided were intravenous therapy (mainly antibiotics), anticoagulation, and wound care. Unplanned patient telephone calls were received in 6.3% of admissions; 5.8% of acute admissions required an unscheduled staff home attendance; 4.2% of episodes resulted in a return to hospital, of which 2.6% required continued care in hospital; 2.2% of episodes resulted in a return to hospital within 14 days of discharge for a related problem. The rate of iatrogenic adverse events was 3.5%. HIH care is very safe. This study may help define safety standards for HIH care so that future studies can compare them with those of traditional inpatient care.