How safe is hospital-in-the-home care?

Objective: To describe the rate of negative, unexpected and adverse events associated with hospital-in-the-home (HIH) care in an established unit, and to validate indicators of safety for HIH care. Design: Prospective descriptive survey. Patients and setting: 231 patients, who would otherwise have required hospitalisation, accepted for acute home-based care by the HIH unit at Frankston Hospital, a 350-bed hospital serving a population of 240 000 on the south-eastern boundary of Melbourne. Main outcome measures: The following indicators of safety: patient telephone calls to the on-call service; unscheduled staff callout to patients' homes; return to hospital during an HIH admission; and return to hospital after discharge. Results: 190 acute admissions were examined. Planned same-day admissions were uneventful and excluded from the analysis. The therapies provided were intravenous therapy (mainly antibiotics), anticoagulation, and wound care. Unplanned patient telephone calls were received in 6.3% of admissions; 5.8% of acute admissions required an unscheduled staff home attendance; 4.2% of episodes resulted in a return to hospital, of which 2.6% required continued care in hospital; 2.2% of episodes resulted in a return to hospital within 14 days of discharge for a related problem. The rate of iatrogenic adverse events was 3.5%. Conclusions: HIH care is very safe. This study may help define safety standards for HIH care so that future studies can compare them with those of traditional inpatient care.