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 hosp ital care to patients at home. This includes the delivery of intravenous th erapy, low molecular weight heparin, and complex wound care that would nece ssitate hospital admission. The development of quality assessment and impro vement 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 H IH 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 admiss ions. 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 r eturn 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 per iod 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 m edication administration error was reported. Patient refusal of HIH was ver y uncommon. Conclusions. Clinical indicators relating to unexpected patient telephone c alls, 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. Howe ver, the findings also suggest a minimum level of service provision, partic ularly in the area of after-hours support, for the safe management of acute hospital care at home.