Measuring the quality of hospital in the home care: a clinical indicator approach

Background. Hospital in the home (HIH) refers to the delivery of acute hospital care to patients at home. This includes the delivery of intravenous therapy, low molecular weight heparin, and complex wound care that would necessitate hospital admission. The development of quality assessment and improvement in HIH has been hampered by several factors. Objective. To (i) develop clinical indicators for HIH care from an analysis of the current literature and test their suitability for implementation by HIH programmes; and (ii) make a preliminary assessment of the quality of HIH care delivered in several HIH units in Victoria, through an examination of clinical indicator data. Design. Prospective descriptive study in 3 consecutive months of HIH admissions. Participants. Nine HIH units in Victoria, Australia. Main outcome measures/interventions. Five clinical indicators for HIH care: unexpected patient telephone calls; unplanned staff call-outs; unplanned return to hospital; medication administration errors; and patient refusal to consent to HIH care. Results. Seven hundred and fifty-nine patient admissions over a 3-month period were included. On average, 10% of patients made an unexpected telephone call, 2.4% of patient admissions required an unplanned staff call-out, and 7.3% of admissions resulted in an unplanned return to hospital. Only one medication administration error was reported. Patient refusal of HIH was very uncommon. Conclusions. Clinical indicators relating to unexpected patient telephone calls, unplanned staff call-outs and returns to hospital are recommended for inclusion in Australia's hospital accreditation programme. On the basis of this study it appears that HIH is a safe and acceptable form of care. However, the findings also suggest a minimum level of service provision, particularly in the area of after-hours support, for the safe management of acute hospital care at home.