HITH pathway providing alternative to inpatient admission

Dr Zaheer Bhikoo

Caboolture Hospital Medicine and Older Persons Service Line Director and Respiratory Physician Dr Zaheer Bhikoo

Caboolture Hospital is improving patient outcomes by providing hospital in the home (HITH) for patients with chronic obstructive pulmonary disease (COPD) as an alternative to inpatient admission.

The pathway has been developed by the hospital respiratory team in collaboration with Community and Oral Health and Metro North Health thoracic specialists.

Within two years, the team has significantly increased the transition of patients admitted with COPD exacerbations from an acute hospital setting to HITH, which has reduced readmission rates and created additional capacity within the hospital system and improved health outcomes of people living with COPD in Caboolture.

They achieved this success by putting patients first and putting a simple idea into action without any additional resources.

COPD is a leading cause of total burden of disease in Australia with significant costs to the Australian healthcare system. In Queensland, COPD is among the top five causes of death.

In the financial year 2021-22, there were more than 3800 hospitalisations across Metro North Health facilities with more than 1100 hospitalisations alone at Caboolture Hospital.

With an average length of stay of about three days, the admissions accounted for approximately 1456 hospital bed days.

Metro North Health’s HITH service provides the same quality of care a person would receive in hospital in the comfort of their home or another patient-selected location. This means that patients are comfortable in familiar settings, often with their family.

Caboolture Hospital Medicine and Older Persons Service Line Director and respiratory physician Dr Zaheer Bhikoo led the respiratory team consisting of respiratory physicians, a respiratory nurse practitioner and respiratory nurse consultant.

Over the last two years, the team have achieved dramatic improvements in patient transfers to HITH and reductions in readmissions within 28 days, by creating and embedding an efficient and patient-centred pathway to safely transition patients with COPD from the acute hospital to HITH.

The Caboolture Hospital Respiratory Team has achieved this by making a focussed effort to consider HITH for every patient with respiratory conditions.

The team moved from asking: “Why should this person go to HITH?” to “Why shouldn’t this person go to HITH?” It meant every patient was considered to move to HITH as soon as medically suitable.

Importantly, Caboolture Hospital has also achieved exceptional outcomes for First Nations people with COPD, with a readmission rate of just 12 per cent compared to 32 per cent across Metro North.

With COPD being one of the major chronic health challenges in Queensland, this simple approach has the potential to have wide-ranging impacts for the people of Queensland and the health system.

HITH usage

Across Metro North in 2021-2022, 88 patients with COPD were transitioned from acute hospital care to HITH. Of those 88, 65 were admitted from Caboolture Hospital. This is 74 per cent of all Metro North HITH admissions for COPD.

14 per cent of all COPD admissions to Caboolture Hospital were transitioned to HITH, compared to an average of 5.2 per cent across Metro North hospitals.


Across Australia, 22 per cent of patients with COPD will require readmission to a hospital within 28 days of discharge. In the last 12 months, the Caboolture Hospital team have reduced their readmission rates to just 15 per cent.

This seven per cent decrease translates to 102 additional bed days made available for other patients requiring acute hospital care. This also means patients with COPD spent an additional 102 days at home, rather than in hospital.

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