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 inpatient hospital bed. The admission criterion is governed by the authorising officer and as such the HITH program is focused on acute and subacute admitted care substitution.
Hospital in the Home (HITH)
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.
- 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
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, 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 in that region, 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 also offer access to allied health, and in addition to providing services to eligible adult patients, also care for eligible paediatric, elderly and mental health patients.
Clinical Excellence Queensland maintains a stewardship role in relation to HITH in Queensland, collaborating with public HITH services statewide (13 of the 16 Hospital and Health Services, in addition to the Mater at Home service) to optimise and enhance HITH service delivery.
- Appointed in late 2020 a 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
- Established Statewide HITH meeting, where HITH services share innovations, learnings and resources
- Coordinated significant investment in early 2020 to rapidly expand the majority of Queensland public HITH services in response to the COVID-19 pandemic, and developed related COVID HITH resources
- Commissioned the facilitation by Health Consumers Queensland in late 2020, of 15 statewide focus groups to obtain consumer feedback on HITH and virtual care
- Re-established HITH Guideline Review Working Group to review HITH Addendum A (underway) and HITH Guideline and HITH recommended minimum requirements/KPIs (to commence early 2021)
- Developed Statewide HITH Dashboard that enables HITH services visibility of statewide public HITH activity data
- Developed multi-modal HITH promotion resources
- Facilitate HITH service rapid reviews at facilities (on request)
- Support 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)
- Provide clinical and non-clinical support to HITH sites
- Explore and champion initiatives that will optimise the uptake of HITH
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 a mechanism to treat patients in their permanent or temporary residence for conditions requiring clinical governance, monitoring and/or input that would otherwise be managed in a traditional inpatient hospital bed. 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 HITH multidisciplinary team is comparable to the services offered in an inpatient hospital setting.
Enquiries regarding how to set up/review a HITH service are available upon request. For assistance please contact the Healthcare Improvement Unit via HIU@health.qld.gov.au.
Partnerships The majority of public HITH services in Queensland are State funded, however some HITH services are provided by a private HITH service provider via a public private partnership arrangement.