Overall goals of HITH during COVID‐19 pandemic
To provide safe, effective patient‐centred care at home for all HITH patients, while managing increased demand for HITH services.
To plan for new clinical pathways to care for COVID‐19 patients.
To minimise the impact of staff shortages.
To minimise the risk of SARS‐CoV‐2 exposure to staff and patients.

Issues to consider in planning for HITH preparedness
It is recommended that all home care services consider what is achievable within current capacity, and the responses to increased demand for HITH services with potentially decreased staff. A checklist of issues to consider can support this process (Fig. 1).
Figure 1  Checklist for optimising hospital‐in‐the‐home (HITH) service during COVID‐19 pandemic.

Managing staffing
Workforce planning: resources required for projected increases in patient numbers, and impact of leave.
Workforce flexibility: changing shift times, teleconferencing from home, especially for those with increased risk from COVID‐19.

Managing HITH equipment use and availability
HITH equipment use: minimising the risk as a source of infection through determining what needs to be in the home, cleaning requirements and lifespan of PPE stored in hot cars.
Equipment stock availability and cars: ensuring sufficient stock or supply chain of usual and additional (PPE, flocked swabs) equipment for the duration of the pandemic.
Telehealth equipment: ensuring good connection; access to videoconferencing is not universal in patients' homes, and may need to be replaced by telephone calls.

Managing patient workload
Measures to decrease current HITH workload will maximise the number of patients that can be transferred home to free up hospital beds.
Managing interventions: minimising simple referrals, frequency of interventions and duration on HITH; 10  education and support of patients remotely in their own care; deferral of elective referrals.
Managing need for in‐home visits: replacement of some in‐home visits with telehealth; 11  use of home observation kits (thermometer, oximeter) with remote monitoring; decreased driving distance, and if too far, engaging local services or rehousing patients locally.

Minimising risk of exposure to and transmission of SARS‐CoV‐2
Staff should follow current health department guidelines for screening, testing and PPE.
Risk factor screening script use: at referral and prior to every visit.
Education and training staff for PPE use: guidance on donning, doffing and waste disposal, because every visit is in an unfamiliar environment.
Limiting exposure during visits: family members should be limited in number, physically distanced and if unwell, not in the room with visiting staff.
Decreasing risk for staff at increased risk (co‐morbidities, increased age): telehealth and non‐clinical duties.

Communications
Communication is critical in ensuring that staff and patients feel informed and supported.
HITH staff: to provide updates and support, emphasise the importance of hand hygiene and other measures and provide moral support.
Hospital staff: to remind referrers of the role and capacity of HITH in ongoing institutional pandemic planning.
General practitioners, community physicians and other healthcare workers: to ensure care is co‐ordinated with other healthcare workers providing supportive care to patients at home.
Patients: to ensure they feel safe receiving home care; development of information for all patients receiving care via HITH during the pandemic and additional information for patients with COVID‐19. 12  This may include child‐orientated language or pictures.