Mapping Scandinavian Hospital-at-Home Organisations and Interventions for Patients With Acute Somatic Illness-A Scoping Review.

Abstract

Introduction: Hospital-at-Home (HaH) has been implemented in several countries. However, HaH interventions vary depending on organisational structures and target populations. In Denmark, Norway, and Sweden, HaH is offered in selected regions and municipalities, often as pilot or quality projects. Currently, there are no guidelines or systematic overviews of Scandinavian HaH models.

Aim: This review aims to map published research that describes Scandinavian HaH organisations, interventions, and patient characteristics for acute somatic illness.

Methods: In this scoping review, papers were identified through a systematic search of Medline, Embase, and CENTRAL, supplemented by a grey literature search. Eligible studies focused on Scandinavian adults (≥ 18 years) with acute somatic illness requiring initial contact with an emergency department (< 24 h), out-of-hours doctor, or a general practitioner. Exclusions criteria were early discharge care, post-discharge care, self-monitoring or single health care contacts. Two researchers screened studies in a two-step process.

Results: Ten studies met the inclusion criteria. Three primary HaH models were identified: (1) municipal acute nursing teams collaborating with general practitioners (GPs) and hospital physicians or municipal mobile acute care with physicians, (2) hospital-affiliated emergency department (ED) teams providing mobile acute care, and (3) specialised acute units integrating virtual and in-person health care. Common interventions included intravenous therapy, point-of-care diagnostics, clinical monitoring and digital consultations. The majority of HaH patients were older adults with multiple chronic conditions, commonly treated for infections, dehydration, or exacerbations of chronic diseases.

Conclusion: Scandinavian HaH can be categorised into three models. The primary distinction between the models lies in the organisational affiliation of the nursing teams, which plays a pivotal role in defining the care structure.