{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:03:58Z","timestamp":1786971838302,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:00:00Z","timestamp":1741305600000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Ambulatory treatment of decompensated heart failure (HF) with intravenous (IV) furosemide through Hospital in the Home (HITH) is safe, effective and reduces costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We hypothesised that this service was underutilised by general medicine and aimed to examine potential barriers and bed\u2010day utilisation implications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this multi\u2010site, retrospective observational study, we identified general medicine inpatients admitted with heart failure (HF) between November 2021 and October 2022. Those who required intravenous (IV) furosemide for &gt;24 h were selected and included if clinically stable. Patients were grouped by \u2018no barriers\u2019, \u2018relative barriers\u2019 and \u2018absolute barriers\u2019 to Hospital in the Home (HITH). We estimated potential brick\u2010and\u2010mortar hospital bed\u2010days that could be transferred to HITH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 1856 admissions coded as HF, 694 met our criteria. Of these, 311 (45%) were clinically stable, while only four were transferred to HITH. Of the remaining 307 patients, 27 (9%), 129 (42%) and 151 (49%) exhibited no, relative and absolute barriers to HITH respectively. Those with no or relative barriers (<jats:italic>n<\/jats:italic> =\u2009156, 51% or 22% of those treated with IV furosemide) had two (interquartile range (IQR) 1\u20133) additional medical diagnoses and spent 4 (IQR 3\u20136) days in hospital while clinically stable. A 36% reduction in brick\u2010and\u2010mortar hospital bed\u2010day utilisation by transferring care to HITH was estimated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In our health service, general medicine patients are rarely referred to HITH for IV diuresis for decompensated HF. Overcoming barriers relating to the ability of the model of care to support greater acute medical complexity could result in increased utilisation of HITH and deliver a significant reduction in brick\u2010and\u2010mortar hospital bed\u2010day utilisation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.16655","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:59:25Z","timestamp":1741741165000},"page":"407-414","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhancing utilisation of Hospital in the Home for intravenous diuretic therapy: a retrospective study of barriers and estimated bed substitution in general medicine inpatients with decompensated heart failure"],"prefix":"10.1111","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3789-9959","authenticated-orcid":false,"given":"Elizabeth","family":"Potter","sequence":"first","affiliation":[{"name":"Department of General Medicine Monash Medical Centre, Monash Health  Melbourne Victoria Australia"},{"name":"School of Clinical Sciences at Monash Health Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Joy","sequence":"additional","affiliation":[{"name":"Department of General Medicine Monash Medical Centre, Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Lock","sequence":"additional","affiliation":[{"name":"Department of General Medicine Monash Medical Centre, Monash Health  Melbourne Victoria Australia"},{"name":"Hospital in the Home Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Richards","sequence":"additional","affiliation":[{"name":"Hospital in the Home Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Rogers","sequence":"additional","affiliation":[{"name":"School of Clinical Sciences at Monash Health Monash University  Melbourne Victoria Australia"},{"name":"Hospital in the Home Monash Health  Melbourne Victoria Australia"},{"name":"Infectious Diseases Unit Monash Health  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,7]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Australian Commision on Safety and Quality in Health Care.Section 2.2. Heart Failure. The Fourth Australian Atlas of Healthcare Variation 2021. Accessed 5 August 2024."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2024.01.016"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.09.013"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2013.08.022"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.15994"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.51385"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2023.07.017"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0129282"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2008.05.012"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.02103.x"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50599"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19149"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39335.541782.AD"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.15213"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1005419"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.7326\/M19-0600"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.7326\/M20-5688"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2007.01459.x"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13394"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15782"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06833-2"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16486"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.21037\/mhealth-24-23"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.16655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T02:58:00Z","timestamp":1743562680000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.16655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":23,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1111\/imj.16655"],"URL":"https:\/\/doi.org\/10.1111\/imj.16655","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2024-10-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}