Qualitative Study of Patient Experience in Home Hospital and Staff Burnout

Abstract

Purpose: “Home Hospital,” where acute services delivered in the inpatient setting are instead provided in the home, maintains quality and safety of care while decreasing costs. The purpose of this study is to analyze the results of semi-structured interviews with patients about their experiences in the Home Hospital clinical trial and to analyze the data from surveys of staff working in the Home Hospital program to assess the impact of novel clinical environments on staff burnout. Methods: The first randomized control trial (RCT) of home hospital in the United States was performed by Levine et al 2018. After discharge, patients in this RCT were called to complete a semi-structured interview about their experience. Interviews were performed until thematic saturation, transcribed, and analyzed using open, axial, and selective coding. In addition, all staff of the home hospital pilot group anonymously completed the Mini Z Burnout and staff experience surveys Results: Both groups noted positive experiences with their clinicians (home, 97% positive vs control, 72% positive), although the home group had fewer negative comments regarding interactions with physicians, nurses, and aides. Compared to control patients, home patients described more factors promoting healing: improved sleep (68% vs 28%), increased physical activity (68% vs 37%), improved social support from family (72% vs 47%), and better environmental comfort (89% vs 34%). Both groups noted difficulties with the discharge process (77% negative 75%). Control patients described more difficulties during their admission from the emergency department to the floor (0% negative vs 55%), more negative experiences with technology (20% vs 80%), and more logistical difficulties in receiving care during their admission (4% vs 48%). For the staff burnout study, 89% of staff completed evaluations. 88% of staff had no symptoms of burnout; 13% was under stress but did not feel burned out. Median overall satisfaction with home hospital was 4.5/5.0 (interquartile range (IQR), 1.0). 50% "entirely" or "very much" preferred home hospital to their standard clinical setting. 75% of staff felt that their opinions were "entirely" heard; 50% felt the team "entirely" valued each of its participants. Conclusions: Compared to traditionally hospitalized patients, home hospital patients had better experiences with their care team, more experiences promoting healing such as better sleep, physical activity, and social support, and better experience with systems factors such as the admission process and technology. In addition, novel clinical care settings like home hospital may lead to low staff burnout, high job satisfaction, and a healthy work environment.