QI in Action: Rethinking Hospital Care for Children with a Paediatric Hospital in the Home Model

We spotlight a QIL project undertaken by Dr Emma Welsman to establish a paediatric Hospital in the Home service on the Sunshine Coast.

The ACHS Improvement Academy’s Quality Improvement Lead (QIL) Program supports healthcare professionals in implementing data-driven improvement initiatives within their organisations.           

Sunshine Coast Hospital and Health Service recognised an opportunity to redesign care by bringing hospital-level treatment into the home for paediatric patients. 

Background 

For many children and families, a hospital admission can be stressful, disruptive and difficult. While hospital care is essential for many conditions, not every child requires ongoing treatment within a hospital ward. 

The Children’s Hospital in Your Residence (CHiYR) project established a dedicated paediatric Hospital in the Home service, allowing eligible children to receive safe, effective care at home while remaining connected to specialist paediatric teams. The initiative demonstrates how redesigning care models can improve patient and family experience, strengthen cultural safety and make better use of healthcare resources. 

The Challenge 

Before CHiYR was introduced, Hospital in the Home services on the Sunshine Coast were primarily designed for adults. The service was externally managed, governed by adult clinicians and generally accepted children only over the age of five. 

As a result, paediatric referrals were limited, children often remained in hospital longer than necessary, and care pathways were not well integrated with paediatric clinical governance.  

The project aimed to establish a paediatric-specific Hospital in the Home service with dedicated staffing, governance and escalation pathways. The initial goal was to admit 50 patients within six months and evaluate safety, patient experience and service performance. 

The Solution 

A dedicated paediatric Hospital in the Home model was developed and integrated within Sunshine Coast Hospital and Health Service. The service included: 

• defined referral pathways 

• dedicated paediatric nursing staff 

• robust medication and escalation processes 

• integrated digital documentation 

• governance aligned with paediatric clinical services. 

The team benchmarked successful models, including Queensland Children’s Hospital, and used quality improvement methods to guide implementation. 

A Structured Improvement Approach 

The project followed a staged quality improvement strategy. The team began by analysing the existing adult-focused model and comparing it with paediatric Hospital in the Home services across Queensland. Stakeholder consultation involved executives, business managers, paediatric clinicians, Hospital in the Home staff and families. 

Process mapping identified barriers across referral, medication management, documentation and escalation. Governance, workforce capability and safety protocols were strengthened before the service was launched.

The Results 

The first CHiYR patient was admitted on 15 March 2024, with the full seven-day service launching in April. 

Within six months, the service achieved: 

• 77 inpatient separations 

• 57 outpatient home visits 

• 306 hospital bed days saved 

The project exceeded its original target of 50 admissions. From May onwards, paediatric Hospital in the Home services consistently exceeded the state benchmark of 1.5% of all paediatric separations, while CHiYR alone accounted for more than 3% of Child and Adolescent Unit separations. 

The service also improved referral pathways, increased direct referrals from the Emergency Department and identified opportunities for future expansion into post-surgical care, wound management, home oxygen therapy and other clinical areas. 

Putting Families at the Centre of Care 

One of the strongest outcomes was the response from children and families. Post-discharge surveys showed an average rating of 4.96 out of 5 for overall experience, feeling safe and supported, and ease of contacting the care team. 

The service achieved a Net Promoter Score of +96.15, indicating exceptionally high family satisfaction and a strong willingness to recommend the service to others. 

Strengthening Cultural Safety 

The project also delivered significant improvements in culturally safe care. Aboriginal and Torres Strait Islander children represented 15% of all CHiYR separations, substantially higher than the regional demographic proportion and overall Hospital and Health Service utilisation rates. 

This suggests the model successfully improved access to home-based care for Aboriginal and Torres Strait Islander families and supported more equitable healthcare delivery. 

Looking Ahead 

Following the successful launch, Sunshine Coast Hospital and Health Service is planning to expand the model by: 

• increasing geographical eligibility 

• expanding referral pathways from Emergency Department and Surgical Unit 

• introducing allied health services such as home chest physiotherapy 

• refining intake and discharge processes 

• continuing KPI and safety monitoring. 

By designing a paediatric-specific Hospital in the Home service with strong governance, dedicated clinical pathways and a focus on family-centred care, the team created a model that improved patient experience, supported cultural safety and reduced demand on inpatient beds. 

The project offers a practical example of how healthcare organisations can redesign services around the needs of patients and families while delivering measurable improvements in quality, safety and resource utilisation. 

Explore projects from QIL Program Graduates        
You can read this full project on pg 37. in the QIL Project Summaries 2024 6th Edition.  

This year's QIL program is underway, but you can register your interest for the next intake. Contact us to see if the program is right for you and how to join the waitlist at improvementacademy@achs.org.au.