Hospital in the Home (HITH)

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Initiative Type
Model of Care
Service Improvement
System Improvement
Status
Sustained
Added
Last updated

Summary

Hospital In The Home (HITH) provides care in a patient’s permanent or temporary residence for conditions requiring clinical governance, monitoring and/or input that would otherwise require treatment in the traditional hospital bed. 

The HITH program is focused exclusively on admitted inpatient care substitution with the admitting criteria governed by the authorised officer. The key feature of the Queensland HITH program is that if the patient (child/adult) were not receiving HITH, the patient would be admitted to hospital for treatment in a traditional hospital bed. Hospital admission criteria types include acute and sub-acute and specific HITH specialised models of care such as:

  • Geriatric Evaluation and Management in the Home (GEMITH)
  • Geriatric Evaluation and Management and Rehabilitation HITH (GEMRHITH)
  • Maternity HITH
  • Palliative HITH, and
  • Mental Health HITH
Key dates
Jul 2017
Implementation sites
Queensland has HITH services across 15 of the 16 Hospital and Health Services, in addition to Mater Health's Mater at Home service and ACCESS services.
Partnerships
The majority of public HITH services in Queensland are State funded, however some HITH services are provided by a private HITH service provider.

Aim

To provide patients greater choice in how and where their care is received, improve access to health services, provide high patient satisfaction  and positive health outcomes, and improve efficiencies in health service delivery.

Benefits

  • Provides patients with a safe and high quality care in the comfort of familiar surroundings without needing to be in hospital.
  • High patient satisfaction and reduced risk of adverse events from hospital admission and re-presentation to emergency departments. 
  • Increased hospital bed capacity with limited capital expenditure required
  • Cost effective, flexible and sustainable solution to manage the increase demand on the acute services

Background

HITH provides care in a patient’s permanent or temporary residence (care settings can include, but are not limited to: residential aged care facilities, hotels, schools, boats, prison, boarding houses and places of work) for conditions requiring clinical governance, monitoring and/or input that would otherwise require treatment in the traditional inpatient hospital bed. The admission criterion is governed by the authorising officer and as such, the HITH program is focused on admitted care substitution. HITH patients are regarded as hospital inpatients, therefore they remain under the care of their hospital doctor, who will be informed of their journey and outcome. The service is free for eligible Queensland public hospital patients who consent and are eligible to transfer to HITH. 

Queensland patient eligibility criteria:

  • patients that without HITH would remain in hospital 
  • patients that require daily treatment and assessment (which can be delivered by various and flexible modes) and
  • patient care can be provided and managed in the patient’s  permanent or temporary residence 

HITH is a model of care implemented with some variability worldwide, including Australia, with each Australian jurisdiction having a slightly different emphasis and in some cases, treating different conditions. The HITH Society Australasia is the peak body that supports HITH clinicians, with the majority of Australian jurisdictions, including Queensland,  also represented on the HITH Interjurisdictional Committee. In Queensland, HITH services deliver (daily, with after-hours support) safe, high quality hospital comparable care delivered in patients homes provided by a highly skilled workforce. Some Queensland HITH services, comprised of dedicated multi-disciplinary teams, deliver  (daily, with after-hours support) safe, high quality hospital comparable care delivered in patients' homes.  


Clinical Excellence Queensland maintains a stewardship role in relation to HITH in Queensland, collaborating with public HITH services statewide to optimise and enhance HITH service delivery. 


 

Solutions Implemented

  • Coordinated significant investment to rapidly expand Queensland HITH services to enable strong  medical governance and dedicated multi-disciplinary teams, related to the Care4Qld Strategy 2021-2024.
  • Established Statewide HITH Collaborative to support HITH service expansion, knowledge sharing and innovation. 
  • Developed Statewide PowerBI HITH Dashboard to enable HITH services visibility of statewide public HITH activity data.
  • Appointment of Statewide HITH Clinical Lead (temporary) to explore strategies to enhance HITH service delivery in Queensland.
  • Established Statewide HITH Working Group to support the development of strategies to optimise the uptake of HITH in Queensland.
  • Coordinated significant investment in 2020 to rapidly expand the majority of Queensland public HITH services in response to the COVID-19 pandemic, and developed related COVID HITH resources.
  • Engaged Health Consumers Queensland (2020) to obtain Queensland health consumer feedback on HITH and virtual care to enhance HITH service delivery.
  • Developed multi-modal HITH promotion resources.
  • Facilitated HITH service rapid reviews at facilities.
  • Supported trial projects aimed at enhancing HITH service delivery i.e. remote patient monitoring, emergency department direct referrals to HITH, geriatric evaluation and management in HITH (GEMHITH), Maternity HITH.
  • Provide clinical and non-clinical support to HITH sites.
  • Explore and champion initiatives that optimise the uptake of HITH.

Evaluation and Results

HITH data and Key Performance Indicators (KPIs) are monitored, analysed and reported via local Hospital and Health Service processes. Service evaluation is important for the ongoing monitoring and evaluation of service level data, to ensure KPIs are met:

  • HITH recommended minimum data set/KPIs for reporting are outlined 
  • To ensure transparency of HITH service delivery , all data (including clinical incident data) is to be made available to key stakeholders

Lessons Learnt

  • HITH is a flexible model of care and sustainable solution to managing increased demand on hospital services. 
  • HITH provides patients with greater choice in how and where they receive their care, improves access to health services, provides high patient satisfaction and positive health outcomes, while improving efficiencies in service delivery. 
  • The level of care and treatment from a dedicated HITH multidisciplinary team is comparable to the services offered in an inpatient hospital setting.

     

 

Further Reading

Queensland Health Hospital in the Home (HITH) Guideline

 

 

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Key contact

Sonya Mizzi
Senior Project Officer
Healthcare Improvement Unit
(07) 3328 9002
Sonya.Mizzi@health.qld.gov.au

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