Organization of patient transfer from conventional hospital to hospitalization at home

Abstract

The organization of patient transfer from conventional hospital to hospitalization at home (HAH) is not well known. Our study aims to describe this organization by identifying the key professionals of the pathways and the incentives and obstacles to the continuity of care. Patient transfer from conventional hospital to HAH is a period of strong tension between all health care professionals and the organization of discharge is not sufficiently anticipated by hospital prescribers. The description of the patient clinical state is not always shared between the conventional hospital and the HAH professionals mainly when they do not work together. An HAH physician can be of support. Finally, the HAH nurse has a main role at the interface of the hospital department, the patient, and the home care professionals with an important activity of coordination of interventions. Patient transfer from conventional hospital to HAH should be anticipated by hospital professionals upon entrance and common needs assessment tools would allow a better security of the pathways.