Hospital at home - developing a simulation induction programme for junior doctors.

Hospital at Home (HaH) provides hospital-level care within patients' homes. With services expanding, a London HaH service embedded new junior doctor posts. Currently, gaps exist in the under- and postgraduate curriculum to develop clinical skills required to deliver care in this context. HaH simulation (HaH-SIM) was developed, through a multi-cycle QIP, to improve early-career doctors' confidence in providing care in this unfamiliar environment. Surveys before and after HaH-SIM assessed confidence in practical, clinical and communication skills; ranked concerns; rated sessions and gained qualitative feedback. 41 doctors participated over 2 years. It currently includes six low-fidelity stations and three high-fidelity stations. Confidence improved, particularly in managing end of life, decision-making around hospital admission and administering intravenous medications/fluids. High-fidelity scenarios, practical skills and prescribing stations were most highly rated. As HaH services expand, HaH-SIM is a feasible, effective and transferable way of improving early-career doctors' confidence and skills to provide care in patients' homes.