title: Efficacy of hospital in the home services providing care for patients admitted from emergency departments: an integrative review.
abstract: BACKGROUND
  Increases in emergency department (ED) demand may compromise patient outcomes, leading not only to overcrowding in the ED, increased ED waiting times and increased ED length of stay, but also compromising patient safety; the risk of adverse events is known to rise in the presence of overcrowding. Hospital in the home (HiTH) services may offer one means of reducing ED demand.
  
  
  OBJECTIVE
  This integrative review sought to assess the efficacy of admission-avoidance HiTH services that admit patients directly from the ED.
  
  
  METHODS
  Papers published between 1995 and 2013 were identified through searches of Medline, CINAHL and Google. English-language studies that assessed the efficacy of a HiTH service and that recruited at least one-third of the participants directly from the ED were included in the review. A HiTH service was considered one that provided health professional support to patients at home for a time-limited period, thus avoiding the need for hospitalization.
  
  
  RESULTS
  Twenty-two articles met the inclusion criteria for this review. The interventions were diverse in terms of the clinical interventions delivered, the range and intensity of health professional input and the conditions treated. The studies included in the review found no effect on clinical outcomes, rates of adverse events or complications, although patient satisfaction and costs were consistently and favourably affected by HiTH treatment.
  
  
  CONCLUSIONS
  Given evidence suggesting that HiTH services which recruit patients directly from the ED contribute to cost-savings, greater patient satisfaction and safety and efficacy outcomes that are at least equivalent to those associated with hospital-based care, the expansion of such programmes might therefore be considered a priority for policy makers.
authors.affiliation: 1St Vincent's Hospital, Melbourne, Victoria, Australia 2The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Varney
authors.forename: Tracey J
authors.initials: TJ
authors.lastname: Weiland
authors.forename: George
authors.initials: G
authors.lastname: Jelinek
mesh_terms: D003363:Cost Control / Q000379:methods; D003441:Crowding; D016206:Databases, Bibliographic; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D018575:Home Care Services, Hospital-Based / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000331:legislation & jurisprudence / Q000639:trends; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D061214:Patient Safety; D017060:Patient Satisfaction; D061665:Time-to-Treatment