Enhancing the Use of Home Hospital in the Emergency Department: A Nurse Practitioner-Led Quality Improvement Project

Emergency department crowding contributes to adverse patient outcomes and resource strain. Home Hospital, which delivers hospital-level care in a patient's home, can reduce inpatient volume while maintaining quality and safety. Although Home Hospital programs offer a viable solution to these systemic pressures, a recognized gap exists between program availability and actual use by emergency department providers.

This quality improvement project used 3 sequential Plan-Do-Study-Act cycles: (1) a self-paced online learning module on eligibility and referral workflow; (2) point-of-care visual aids at provider workstations; and (3) integration of standardized referral guidance into the emergency department provider manual for sustainability, along with referral data sharing and a QR code link for feedback. The primary outcomes included the proportion of Home Hospital referrals originating in the emergency department and provider confidence with eligibility and referral steps, measured pre- and postintervention using the Home Hospital Clinician Perception Survey and electronic medical record data.

During the 3 months before the intervention, 5 of 259 referrals (1.9%) originated in the emergency department. Following the intervention, emergency department--initiated referrals increased significantly to 47 of 266 (17.7%; P < .001), with an odds ratio of 10.9. Provider confidence in identifying eligible patients increased from 41% to 94%, and confidence in completing the referral process increased from 41% to 84%. Provider engagement was high; participation rates reached 94% for the online module and 82% for the visual aids.

Embedding a low-cost, multi-component strategy into existing workflows was associated with an increase in emergency department--initiated Home Hospital referrals and an increase in provider confidence. This approach is scalable and supports timely, patient-centered alternatives to hospital admission.