What is Hospital at Home?

This consensus definition of Hospital at Home was presented at the World Hospital at Home Congress in Barcelona on 30th March 2023, by Professor Michael Montalto:

Hospital at Home is an acute clinical service that takes staff, equipment, technologies, medication, and skills usually provided in hospitals and delivers that hospital care to selected people in their homes or in nursing homes. It substitutes for acute inpatient hospital care.

Hospital at Home IS:

Subject to regulatory and governance obligations
Care is hospital-directed by specialist physicians
Fully responsible for the patient, providing all medical, nursing and allied healthcare
Diagnostics, therapeutics and observation are delivered at home during the episode of care
24 hours a day, 7 days a week

Hospital at Home is NOT:

Outpatient care (thus, not self-administered intravenous treatment, and not OPAT)
A hospital prevention programme
A community-based chronic disease management programme
Solely virtual care or remote telemonitoring
Day facility-based treatment
Primary home care
Community nursing or standard skilled home healthcare

Key features of Hospital at Home

Most powerful features.

Acuity and Complexity

The acuity and complexity of the patient condition differentiates Hospital at Home from other community services

Hospital-Level Diagnostics

It provides urgent access to hospital-level diagnostics (such as endoscopy, radiology, or cardiology) and may include bedside tests such as point of care (POC blood tests) and point of care ultrasound (POCUS).

Hospital-Level Interventions

It provides hospital-level interventions (such as access to intravenous fluids, therapy and oxygen)

Daily Input

It requires daily input from a multidisciplinary team and sometimes multiple visits and provisions for 24 hour cover with the ability to respond to urgent visits.

Specialist Leadership

It requires secondary care level specialist leadership and clear lines of clinical responsibility.

Inclusion and Exclusion criteria

Defined inclusion and exclusion criteria, with defined target population, for example for patients aged over 18 or over 65 years.

These programs deliver a time-limited, short-term intervention of 1-14 days

Typical Features of Hospital at Home

Patients are treated as though admitted to hospital, but managed within their own home
Care is delivered by a multidisciplinary team or the programme has access to MDT professionals through other community-based programmes. There is good role definition and clear responsibilities in these programmes
These programmes are an adjunct to, and compliment, other community-based healthcare initiatives which support patients to remain in their own home
Referrals can be either admission avoidance or early supported discharge, depending on the source of the referral and clinical pathways
Care is designed to be patient and family centred in partnership with the team
Clear defined clinical pathways and protocols

Hospital at Home is Not:

There are many perceptions of what Hospital at Home is. Here is a list of what Hospital at Home is not.

Enhanced primary care programmes (e.g. GP extensivist roles or Virtual Wards)
- There are many excellent examples of enhanced primary care provision and Hospital at Home should be complementary to these.
Chronic disease management
- Hospital at home is about acute illness management and whilst it may manage acute exacerbations of chronic disease, as with hospital care the responsibility and expertise for ongoing chronic disease management remains with the primary care team and outpatient specialist care.
Intermediate care
- It is an acute model for an acute medical condition potentially alongside rehabilitation needs but it is not designed for the management of medically stable patients.
Day Care
- Hospital at home is not designed for the management of stable ambulant patients.
Admission prevention
- Hospital at home is not intended to prevent access to specialist acute care. Admission prevention programmes that focus on chronic disease management and high risk categories such as frailty are best placed to prevent decline leading to admission. Hospital at Home is about alternatives to traditional admission for patients who are acutely unwell and still require the individual to be admitted to an acute care team and under clinical governance as though in hospital.

Terminology

Various terms may be used for Hospital at Home internationally, including Hospital in the Home (HITH) and Home Hospital.

The term 'virtual wards' has been used in England, in reference to Hospital at Home services. In August 2024, the UK Hospital at Home Society, the British Geriatrics Society and the Royal College of Physicians released a Joint Statement advocating for the formal adoption of the term 'Hospital at Home', instead of 'virtual wards', to more accurately represent the care delivery and required skills for providing hospital-level care at home, and to improve clarity for patients about the care these services can offer. The Joint Statement can be read here.

Additional Notes

Not all Hospital at Home services start fully fledged and many are developing, so we recognise that these descriptions are to some degree aspirational but important nonetheless.

Many Hospital at Home teams are integrated with other services, such as intermediate care, for example. This can have real practical benefits for the management of patients. However, the definitions remain important to be clear which elements of the work represent hospital replacement (admission avoidance) and which aspects represent additionality (patients who would not need to be admitted).

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