Factors associated with the workload of health professionals in hospital at home: a systematic review

Abstract

Background Understanding the factors related to workload, could help hospital at home (HaH) managers to make decisions on the most appropriate and efficient use of the HaH services. Published studies on this topic are scarce, so we have conducted a systematic review to identify such factors according to published evidence. Methods Due to the heterogeneity of HaH models, HaH was defined as a care that provides a set of medical and nursing care and attention of hospital rank to patients at home, when they no longer require hospital infrastructure but still need active monitoring and complex care. The electronic data base literature search was conducted in MEDLINE (Ovid), EMBASE (Ovid), and Cinahl (EBSCOhost) from inception to December 2021, including grey literature. Search terms related to `hospital at home´, `workload´ and `care time´ were used. There was no restriction on language, type of study or year of publication. Quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist and certainty in the body of evidence was assessed using the GRADE Pro Tool. Results were summarised in a tabulated format. Results Eighteen studies with 56,706 patients were included. Workload was measured as time, number of visits or both. The predictive factors of the workload included variables related to patient characteristics and other valid and reliable patient classification systems, as well as characteristics of the institutions where the studies were conducted. The factors associated with higher workloads were: being older, male, living in a rural environment, presenting a higher number of diagnoses, having worse functional status and being unable to assume self-care. Conclusions The identified predictors of workload are mostly associated with home nursing care. The results could be useful and applicable to different organisational models of HaH health systems. More studies that include physicians and proxy measures of workload are needed.

Risk assessment of healthcare workers’ exposure to physical load in relation to patient handling and movement: a feasibility study of the instrument TilThermometer

“…Acknowledging the significance of mobility during hospitalization, alongside recognizing the adverse impacts of immobility, is a crucial initial stride towards developing effective interventions promoting mobility and independence [ 35 ]. The care recipients’ health and functional status is also directly related to the HCWs' workload [ 36 ]. Patient-related factors such as older age, several diagnoses, low functional status, and being unable to self-care, are some of the identified risk factors for increased HCW workload [ 36 ].…”

“…The care recipients’ health and functional status is also directly related to the HCWs' workload [ 36 ]. Patient-related factors such as older age, several diagnoses, low functional status, and being unable to self-care, are some of the identified risk factors for increased HCW workload [ 36 ]. Greater functional independence and higher mobility levels in patients have shown to reduce staff levels of care [ 37 ].…”

Patients' and caregivers' perceptions of the quality of hospital‐at‐home service: A scoping review

“…Therefore, building strong relationships with patients and caregivers and providing high‐quality care are key factors in promoting positive experiences and improving healthcare outcomes for HaH patients. However, the workload, burden and payment for staff in the HaH care team remain significant issues, the operational deployment of staff, creating sustainable reimbursement and providing a safe practice environment should be considered and addressed when engaging staff and requiring them to have adequate competency and good job performance (Cordero‐Guevara et al, 2022; Kadakia et al, 2022; Karacaoglu & Leask, 2021).…”

“…As proposed by Brody et al, electronic health records for tracking comprehensive personal treatment data and virtual health techniques for collecting real-time data should be further developed to meet patients' needs (Brody et al, 2019). Furthermore, to ensure patient safety and continuity of care, various technology innovations can be considered, including remote monitoring, telemedicine, point-of-care support and efficient allocation of healthcare professionals (Cordero-Guevara et al, 2022;Denecke et al, 2023). These measures can help patients receive appropriate, effective and continuous care at home, while also improving the efficiencies of involving patients, caregivers and healthcare professionals in the care delivery pathways and keeping them informed of any updates.…”

Digital health as an enabler for hospital@home: A rising trend or just a vision?

“…Existing reviews of hospital@home care approaches focus on the effectiveness and costs (2), factors associated with the workload of healthcare professionals (7), or with perceptions of patients and healthcare professionals (8). A Cochrane review published in 2016 found that "admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a selected group of elderly patients requiring hospital admission" (2).…”