The way in which hospital beds are used is constantly changing. Demand on hospitals in developed countries [1] has been influenced by a growing, ageing population with more chronic health problems and rapid advances in healthcare technology [2,3]. To meet this rising demand within a constrained funding envelope, inpatient healthcare delivery has also evolved. These changes include a move to day-case [4] and ambulatory care pathways (care delivered without a traditional inpatient bedbase) [5], strategies to avoid admission to hospital [6], rapid discharge interventions including to intermediate care facilities (such as respite, reablement or rehabilitation services outside of an acute hospital) [7] and centralisation of services [8]. The number of inpatient beds per population varies greatly globally, even in developed countries [9], driving innovation for alternative healthcare technologies. Despite the introduction of these changes, the hospital system continues to experience staffing shortages, insufficient funding, inadequate space and deteriorating estate, outdated and insufficient provision of IT, falling bed numbers, long waits and waiting lists.

The COVID-19 pandemic has further highlighted and exacerbated the challenges that global healthcare has been facing. Staff were redeployed and procedures cancelled [10], creating a backlog of care and impacting on healthcare professional training [11]. At the same time, COVID-19 highlighted inequities in care provision [12] and the importance of investing in staff welfare [9,13]. As the global health systems face unprecedented pressures, there is recognition that the healthcare system needs to learn, be able to flex and adapt so that it can respond effectively now and in the future. The COVID-19 context has therefore created opportunities to explore and accelerate improved and innovative care models that release inpatient bed capacity in a safe and effective manner [14]. Examples include enlisting the help of the private sector, rapidly evolving digital health technology [15] and providing hospital level care at home [16].

The recent challenges have accelerated the emergence and development of Hospital at Home (H@H) programmes across the globe [12]. H@H is a treatment model that delivers acute healthcare treatment in the patient’s usual place of residence. This model of care has existed in isolated pockets worldwide for several decades, however there is significant variation between how they are organised and delivered. Studies have also demonstrated similar mortality rates between those admitted to hospital and those treated at home [17]. The additional benefits include a reduction in those needing long term residential care following acute illness and reduction in delirium [17]. The key services that unite these differing models is that they provide some element of acute care that under a traditional healthcare model would have been administered as an inpatient in an acute hospital setting.

There is no internationally recognised definition of H@H, however within the UK, the UK Hospital at Home society released the following consensus statement [18]:

“Hospital at home provides intensive hospital level care for acute conditions that would normally require an acute hospital bed, in a patient’s home for a short episode through multidisciplinary healthcare teams”.

Other services from around the world have similar explanations of their services describing a hospital level intervention. In the UK these have often been termed virtual wards, and have received increasing support from the UK government through NHS England to roll out more comprehensive virtual wards delivering H@H interventions [19]. In the USA, an Acute Hospital Care at Home waiver announced during the pandemic [20] has allowed patients to receive at home care and providers gain reimbursement through their insurance programmes in some parts of the country.

Central to the delivery of the hospital level care is the ability to deliver medications within the patient’s home. This is critical in order to act in a timely fashion to the patient’s condition, clinical assessment and point of care diagnostics. This includes medications traditionally restricted to a hospital setting such as intravenous therapies and oxygen. Currently there is no evidence supporting the delivery of medicines and medicines management within the H@H model. With a wide variation in definition and delivery models of H@H services worldwide, describing these will assist with the understanding of services to support the development of future H@H programmes in the current climate.