Implementation and evaluation of a COVID-19 rapid follow-up service for patients discharged from the emergency department

Bell, Lucy; Norris-Grey, Caitlin; Luintel, Akish; Bidwell, Gabriella; Lanham, David; Marks, Michael; Baruah, Tim; O'Shea, Luke; Heightman, Melissa; Logan, Sarah

doi:10.7861/clinmed.2020-0816

Cited by 39 publications

(63 citation statements)

References 12 publications

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“…This is the rationale behind the virtual ward remote monitoring model for covid-19, which has been introduced in some settings (including, in England, the Covid Oximetry@Home service led from primary care19 and post-hospital assessment models led from secondary care3334). Figure 1 shows a virtual ward consultation occurring by video.…”

Section: Virtual Wards: a Service Model To Support Home Monitoringmentioning

confidence: 99%

“…Home oximetry and virtual ward support could potentially save many lives by enabling patients requiring hospitalisation to be identified earlier, while also conserving hospital beds and reducing the risk of nosocomial infection. As the evidence base for the efficacy, safety, and acceptability of such models is now accumulating,3334424344 some unanswered questions remain, for which further research is needed, including the impact of home monitoring on patient outcomes (box 3).…”

Section: Virtual Wards: a Service Model To Support Home Monitoringmentioning

confidence: 99%

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Remote management of covid-19 using home pulse oximetry and virtual ward support

Greenhalgh

Knight

Inda-Kim

et al. 2021

BMJ

133

139

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Section: Virtual Wards: a Service Model To Support Home Monitoringmentioning

confidence: 99%

Section: Virtual Wards: a Service Model To Support Home Monitoringmentioning

confidence: 99%

Remote management of covid-19 using home pulse oximetry and virtual ward support

Greenhalgh

Knight

Inda-Kim

et al. 2021

BMJ

133

139

View full text Add to dashboard Cite

“…Three studies included some degree of detail in relation to the categorization of patients in relation to risk [ 14 , 17 , 18 , 19 ]. O'Keefe and colleagues [12] described and evaluated a risk assessment model based on age, medical history and symptom severity.…”

Section: Resultsmentioning

confidence: 99%

“…The use of apps for monitoring allowed the follow-up of a higher number of patients (compared to paper-only models) but some of the studies indicated that models based on telephone calls were more inclusive (i.e. including patients without internet access or technological literacy) [19] . Patient experience was captured in some of the articles we reviewed [ 8 , 26 ] but the analysis was limited.…”

Section: Discussionmentioning

confidence: 99%

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review

Vindrola‐Padros¹,

Singh²,

Sidhu³

et al. 2021

eClinicalMedicine

121

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Background the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. Methods we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. The search was updated on February 2021. We used the PRISMA statement and the review was registered on PROSPERO (CRD: 42020202888). Findings the review included 27 articles. The aim of the models was to maintain patients safe in the appropriate setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/career training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored. Interpretation future research should focus on staff and patient experiences of care and inequalities in patients’ access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools.

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“… 16 In United Kingdom, remote pulse-ox was also used to follow-up with ED patients discharged to home within 36 hours if their symptoms persisted or worsened. 17 In The Netherlands, hospitalized patients with COVID-19 were eligible for early discharge with telemonitoring devices, which reduced length of stay and improved management of volume surges. 18 …”

Section: Introductionmentioning

confidence: 99%

A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19

et al. 2022

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Objectives Since 2020, COVID-19 has infected tens of millions and caused hundreds of thousands of fatalities in the United States. Infection waves lead to increased emergency department utilization and critical care admission for patients with respiratory distress. Although many individuals develop symptoms necessitating a ventilator, some patients with COVID-19 can remain at home to mitigate hospital overcrowding. Remote pulse-oximetry (pulse-ox) monitoring of moderately ill patients with COVID-19 can be used to monitor symptom escalation and trigger hospital visits, as needed. Methods We analyzed the cost-utility of remote pulse-ox monitoring using a Markov model with a 3-week time horizon and daily cycles from a US health sector perspective. Costs (US dollar 2020) and outcomes were derived from the University Hospitals’ real-world evidence and published literature. Costs and quality-adjusted life-years (QALYs) were used to determine the incremental cost-effectiveness ratio at a cost-effectiveness threshold of $100 000 per QALY. We assessed model uncertainty using univariate and probabilistic sensitivity analyses. Results Model results demonstrated that remote monitoring dominates current standard care, by reducing costs ($11 472 saved) and improving outcomes (0.013 QALYs gained). There were 87% fewer hospitalizations and 77% fewer deaths among patients with access to remote pulse-ox monitoring. The incremental cost-effectiveness ratio was not sensitive to uncertainty ranges in the model. Conclusions Patient with COVID-19 remote pulse-ox monitoring increases the specificity of those requiring follow-up care for escalating symptoms. We recommend remote monitoring adoption across health systems to economically manage COVID-19 volume surges, maintain patients’ comfort, reduce community infection spread, and carefully monitor needs of multiple individuals from one location by trained experts.

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Implementation and evaluation of a COVID-19 rapid follow-up service for patients discharged from the emergency department

Cited by 39 publications

References 12 publications

Remote management of covid-19 using home pulse oximetry and virtual ward support

Remote management of covid-19 using home pulse oximetry and virtual ward support

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review

A Cost-Utility Analysis of Remote Pulse-Oximetry Monitoring of Patients With COVID-19

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