A Future for the Hospital‐in‐the‐Home (HITH) Deteriorating Patient: Shifting the Paradigm

The Australian Commission on Safety and Quality in Health Care (ACSQHC) defines health service standards of care, including “recognising and responding to acute deterioration” in a patient's physical, cognitive or mental state.Currently, systems for managing deteriorating patients focus on hospital‐located patients with escalation when mismatches in “clinical needs and the local resources to manage them” are identified.In hospitals with rapid response teams, rates of activation of these teams vary considerably (1.35–71.3 per 1000 admissions). Mixed efficacy in improving patient outcomes is observed, with concern regarding cost‐effectiveness, sustainability, disruption to usual hospital routines, mortality as an outcome measure, deskilling of ward staff, and the impact on patient‐centred care and doctor–patient relationships, especially in end‐of‐life care.