Safety and Clinical Outcomes of Hospital in the Home

Abstract

Objectives The aim of the study was to evaluate clinical outcomes and adverse events (AEs) experienced by patients treated within the Hospital in the Home (HITH) service of a major metropolitan hospital in South Australia. Methods A retrospective case note audit of 100 HITH episodes among adults who received continuous intravenous antimicrobial therapy via an elastomeric or electronic infusion device was undertaken. Age- and sex-adjusted binomial logistic regression analyses were undertaken to identify factors associated with major and minor AEs. Results Of the 100 patients included, 71 were male and the mean (SD) patient age was 62.8 (17.19) years. Elastomeric infusion devices were used for 98 patients. The mean (SD) HITH treatment duration was 20.1 (11.9) days. Overall, 130 AEs were documented for 72 patients (72%), of whom 12 patients experienced a major AE and 68 patients experienced a minor AE. There were 45 occasions among 23 patients where an infusion administered through an elastomeric device did not run to completion. Fifteen patients were readmitted to hospital. Minor AEs were more likely among people with more vascular line days (adjusted odds ratio [aOR] = 1.05; 95% confidence interval (CI) = 1.01–1.10 per day increase) and females (aOR = 4.43; 95% CI = 1.14–17.17). An increased number of vascular line days was associated with an increased likelihood of an incomplete infusion (aOR = 1.05; 95% CI = 1.01–1.09). Hospital readmission was more likely with increasing age (aOR = 1.06; 95% CI = 1.01–1.11 per year increase). Conclusions Adverse events need to be monitored carefully when HITH treatment is provided for extended periods.

Observational study of the incidence and factors associated with patient readmission from home‐based care under the Hospital in the Home programme

“…Other studies have supported the finding that age and comorbidities predict readmission. A recent study from South Australia evaluating clinical outcomes within HITH showed a 6% increase in the odds of readmission per 1‐year increase in age 5 . Montalto et al .…”

“…Since its introduction to Australia, HITH programmes have been expanding across the country. In New South Wales, there were 25 500 HITH admissions in 2017 5 . Victorian HITH services have also grown, and there are currently 52 HITH service sites across Victoria 6 .…”

“…However, there are limited published data that evaluate the overall performance of the services delivered. A previous audit of a South Australian HITH programme showed that 15% of patients required a hospital readmission 5 . Hospital readmissions prior to completion of clinical care are undesirable and represent a key performance indicator for the success of HITH services.…”

“…In New South Wales, there were 25 500 HITH admissions in 2017. 5 Victorian HITH services have also grown, and there are currently 52 HITH service sites across Victoria. 6 However, there are limited published data that evaluate the overall performance of the services delivered.…”

“…A previous audit of a South Australian HITH programme showed that 15% of patients required a hospital readmission. 5 Hospital readmissions prior to completion of clinical care are undesirable and represent a key performance indicator for the success of HITH services. Further studies are necessary to evaluate the nature and extent of the problem and to determine the factors associated with hospital readmission.…”