Key summary points
To understand challenges and opportunities for service development for Hospital at Home (HaH) through interviews with multidisciplinary staff across three services in Scotland.
AbstractSection FindingsFour themes emerged: raising referral awareness, service design and efficiency, staff security on home visits and sustainability.
AbstractSection MessageThe HaH staff interviewed are enthusiastic about these services while raising important challenges to address during service expansion.
Abstract
Purpose
Hospital at Home (HaH) services are expanding to provide acute multidisciplinary care in an individual's home. In this pilot study, we interviewed HaH staff to understand challenges and opportunities for service development.
Methods
We conducted 23 semi-structured interviews with multidisciplinary staff working across three HaH services in Scotland. The questions focussed on service strengths and challenges.
Results
Four themes emerged: raising referral awareness, service design and efficiency, staff security on home visits, and sustainability. HaH staff described Emergency Department posters, experience days for non-HaH staff, and daily communication of virtual bed capacity to raise awareness for referrals. Ideas for maximising clinician time were prioritised to improve service efficiency and investment in electric vehicles was strongly supported to mitigate climate impact.
Conclusion
We found high job satisfaction and engagement amongst HaH staff. Our interviews suggest enthusiasm for further development of HaH while raising important challenges to address during service expansion.
This is a preview of subscription content, log in via an institution to check access.
References
Covinsky KE, Palmer RM, Fortinsky RH et al (2003) Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc 51(4):451–458
Singh S, Gray A, Shepperd S et al (2022) Is comprehensive geriatric assessment hospital at home a cost-effective alternative to hospital admission for older people? Age Ageing 51(1):afab220
Leff B, Burton L, Mader S et al (2006) Satisfaction with hospital at home care. J Am Geriatr Soc 54(9):1355–1363
Edgar K, Iliffe S, Doll HA, Clarke MJ, Gonçalves-Bradley DC, Wong E, Shepperd S (2024) Admission avoidance hospital at home. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD007491.pub3
Covid-19 and the workforce: filling gaps and feeling overwhelmed. Royal College of Physicians Report. https://www.rcplondon.ac.uk/projects/outputs/covid-19-and-workforce-filling-gaps-feeling-overwhelmed. Accessed 20 Oct 2023
NHS to expand services to keep vulnerable out of hospital (UK Government report). https://www.gov.uk/government/news/nhs-to-expand-services-to-keep-vulnerable-out-of-hospital. Accessed 20 Oct 2023
More investment into hospital at home (Scottish Government report). https://www.gov.scot/news/more-investment-in-hospital-at-home/. Accessed 20 Oct 2023.
González-Colom R, Carot-Sans G, Vela E et al (2024) Five years of Hospital at Home adoption in Catalonia: impact, challenges, and proposals for quality assurance. BMC Health Serv Res 24:154. https://doi.org/10.1186/s12913-024-10603-1
Taylor SP, Golding L (2021) Economic considerations for hospital at home programs: beyond the pandemic. J Gen Intern Med 36(12):3861–3864
Knight T, Lasserson D (2022) Hospital at home for acute medical illness: The 21st century acute medical unit for a changing population. J Intern Med 291(4):438–457
Shi C, Dumville J, Rubinstein F, Norman G, Ullah A, Bashir S, Bower P, Vardy ERLC (2024) Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components. BMC Med 22(1):145. https://doi.org/10.1186/s12916-024-03312-3
Tuominen J, Tölli S, Häggman-Laitila A (2023) Violence by clients and patients against social and healthcare staff—an integrative review of staff’s well-being at work, implementation of work and leaders’ activities. J Clin Nurs 32(13–14):3173–3184
Acknowledgements
The authors gratefully acknowledge the time of hospital at home staff across South East Scotland who contributed to this study.
Funding
No funding was received for conducting this study. This study was reviewed favourably by the University of Edinburgh’s student project ethical review panel. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.
Author information
Authors and Affiliations
Contributions
AA and AD contributed to the study conception. MMA and HS are joint first authors of this paper. MMA, HS, AA contributed to the draft of the manuscript. Data collection was performed by MMA, HS, NL, HC, CM, AH, AH, ET. All authors contributed to the revision of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there are no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Anwar, M.M., Shamaz, H., Li, N. et al. The future of hospital at home: a qualitative interview study of healthcare staff. Eur Geriatr Med (2024). https://doi.org/10.1007/s41999-024-00982-3
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s41999-024-00982-3