Providing additional care to patients at home instead of in hospital after emergency department admission increases patient satisfaction and reduces cost of care, while resulting in similar health outcomes

Varney J, Weiland TJ, Jelinek G  Efficacy of hospital in the home services providing care for patients admitted from emergency departments: An integrative review  International Journal of Evidence-Based Healthcare. 2014 Jun;12(2):128-41

Review question

Does providing additional care to patients in their homes instead of at a hospital after being treated in an emergency department lead to improvements in patient satisfaction, clinical outcomes and cost savings?

Background

Demand for care in emergency departments is increasing, leading to overcrowding and greater wait times for hospital beds.

After being treated in the emergency department, patients requiring additional care are most often treated in hospital. Patients could alternatively receive care in their homes as part of Hospital in the Home Services (HiTH).

Previous evidence has shown that treating patients in their homes instead of at hospitals is a promising means of reducing demand for hospital beds and of reducing the cost of care.

How the review was done

Several electronic databases were searched for studies published between 1995 and 2013. Studies that focused on home-care services which admitted patients directly from the emergency department, and which measured patient mortality, clinical outcomes, safety, patient satisfaction, adverse events, costs, and length of stay in hospital, were included.

A total of 269 studies were identified in the initial database search, and 22 were included in the review.

This study was funded by the Department of Health, Victoria, Australia.

What the researchers found

Studies included in the review consistently found that HiTH was no different from hospital care when comparing patient mortality, clinical outcomes, or rates of medical complications.

Studies included in the review also consistently found that HiTH care leads to greater patient satisfaction, and had an unclear or neutral effect on carer satisfaction.

Most studies found that HiTH programs that admit patients from the emergency department are associated with lower costs compared with hospital-based care.

Conclusion

Evidence suggests that HiTH programs contribute to cost-savings, and result in greater levels of patient satisfaction while displaying equivalent safety and clinical outcomes. As such, the expansion of HiTH programs might be considered.