JMIR Publications

ABSTRACT

Background:

Hospital in the Home (HITH) provides home-based care as an alternative to traditional hospitalization. In response to the COVID-19 pandemic, a 350-bed acute care public hospital in the rural Western portion of Southeast Queensland launched a virtual HITH service on December 19, 2021. This service targeted COVID-19-positive patients with additional health concerns, including pregnancy and chronic conditions. Despite accelerated adoption of virtual care modalities within HITH services during the pandemic, evidence for implementing such models for COVID-19 patients remains limited.

Objective:

This study evaluated the feasibility, safety, acceptability, and impact of a virtual HITH service for moderate-severity COVID-19 patients in Queensland, Australia, and identified potential improvements for service uptake and sustainability.

Methods:

Using the RE-AIM framework, a mixed-method approach was employed to assess individual and system-level outcomes. Quantitative data on service utilization and costs were extracted from electronic health records and financial documentation, while qualitative insights came from interviews with service providers and patients.

Results:

As a preventative care initiative, this virtual-enabled HITH model of care successfully provided continuous access to care to the community, while reducing hospital bed occupancy and alleviating system-wide pressures. During the 11-month operational period, the service admitted 3,192 patients. 66 patients were safely discharged early from physical wards to virtual care, while only 12 patients (0.4%) required escalation to in-hospital care. No ICU transfers or deaths occurred. The median length of stay was 5 days (IQR: 4–6), with a 28-day readmission rate of 6.8%. Interviews with 7 staff members and 9 patients revealed high satisfaction levels. Patients valued continuous access to care during limited primary care availability and reported better recovery experiences at home. Staff emphasized the preventative role of the service in identifying high-risk patients and reducing unnecessary hospitalizations, thereby preserving critical hospital resources. Implementation challenges included lack of community awareness, staffing shortages, fluctuating patient volumes, and competition for resources. Despite these barriers, staff demonstrated remarkable adaptability in navigating the rapid evolution of government directives, referral processes, and rapid patients’ turnover. The service enhanced workforce skills and strengthened organizational capacity for future virtual care expansions.

Conclusions:

This study demonstrates successful implementation of a virtual HITH service that provided safe alternatives to inpatient care during COVID-19 Omicron surges. Findings emphasize the importance of adequate planning to establish the base resources and staffing profile for future pandemic responses, and support expanding this model of care into other clinical domains, given its positive impact on patient outcomes and hospital efficiency.