The experiences of hospital staff with decision-making concerning patient enrolment in hospital at home services: A complex and dynamic process

TL;DR

Hospital staff face complex decisions when enrolling patients in hospital at home services, highlighting the need for support and ethical considerations.

Contribution

This study provides novel insights into the decision-making experiences of hospital staff regarding patient enrollment in hospital at home services.

Findings

Hospital staff described a complex and dynamic decision-making process for patient enrollment.

Themes identified include patient eligibility, collaboration with municipalities, and contextual factors within hospital units.

High-quality decision-making is critical for ensuring positive outcomes in hospital at home services.

Abstract

Hospital at home care services offer a potential solution to the problem of strain on hospital beds while simultaneously enhancing patient outcomes. Nevertheless, implementation of the hospital at home care model is associated with several challenges. One such barrier involves patient enrolment, particularly during the initial stage of service operation. Due to their frontline experience, healthcare professionals possess valuable insights that can help us understand and address this challenge. This study aimed to explore the experiences of hospital staff in the decision-making process concerning patient enrolment in hospital at home.

In total, 22 semi-structured individual interviews were conducted with hospital staff members between January and May 2022 at the participants’ workplace or in a public office depending on their preferences. Data were analysed using reflexive thematic analysis.

We identified four themes pertaining to the experiences of hospital staff with the decision-making process concerning patient enrolment in hospital at home: “beneficial for the patients; an important motivating factor”, “patient eligibility; prioritizing safety”, “contextual factors within hospital ward units; opportunities and limitations”, and “collaboration with municipalities; crucial but challenging”.

Hospital staff described a complex and dynamic decision-making process when considering patient eligibility for enrolment to hospital at home services. The findings highlight both barriers and enablers pertaining to this process and emphasize the need to provide support to hospital staff as they navigate this complex situation. A key finding pertains to the critical importance of high-quality decision-making in ensuring positive outcomes and the overall effectiveness of hospital at home care services. Additionally, this study proposes a deeper exploration of the ethical considerations associated with balancing the goal of patient safety with that of equitable access to high-quality, person-centred care within the context of hospital at home.

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