Rapid Telehealth-Centered Response to COVID-19 Outbreaks in Postacute and Long-Term Care Facilities

Abstract

Purpose: The vulnerability of postacute and long-term care (PA/LTC) facility residents to COVID-19 has manifested across the world with increasing facility outbreaks associated with high hospitalization and mortality rates. Systematic protocols to guide telehealth-centered interventions in response to COVID-19 outbreaks have yet to be delineated. This article is intended to inform PA/LTC facilities and neighboring health care partners how to collaboratively utilize telehealth-centered strategies to improve outcomes in facility outbreaks. Methods: The University of Virginia rapidly developed a multidisciplinary telehealth-centered COVID-19 facility outbreak strategy in response to a LTC facility outbreak in which 41 (out of 48) facility residents and 7 staff members tested positive. This strategy focused on supporting the facility team remotely using rapidly deployed technologic solutions. Goals included (1) early identification of patients who need their care escalated, (2) monitoring and treating patients deemed safe to remain in the facility, (3) care coordination to facilitate bidirectional transfers between the skilled nursing facility (SNF) and hospital, and (4) daily facility needs assessment related to technology, infection control, and staff well-being. To achieve these goals, a standardized approach centered on daily multidisciplinary virtual rounds and telemedicine consultation was provided. Results: Over a month since the outbreak began, 18 out of 48 (38%) facility residents required hospitalization and 6 (12.5%) died. Eleven facility residents have since returned back to the SNF after recovering from their hospitalization. No staff required hospitalization. Conclusions: Interventions that reduce hospitalizations and mortality are a critical need during the COVID-19 pandemic. The mortality and hospitalization rates seen in this PA/LTC facility outbreak are significantly lower than has been documented in other facility outbreaks. Our multidisciplinary approach centered on telemedicine should be considered as other PA/LTC facilities partner with neighboring health care systems in responding to COVID-19 outbreaks. We have begun replicating these services to additional PA/LTC facilities facing COVID-19 outbreaks.

A rapid systematic review of measures to protect older people in long term care facilities from COVID-19

“…Twenty studies report the nature of LTCFs related with outbreaks and transmission of COVID-19 infection (Table 2; 16,23,28,29,31,33,35-39,41-43,45-47,50-52 ). Thirty studies (Table 3a; 17-29,32-34,37-43,45-50,53 ) report evidence of measures to reduce transmission of COVID-19 in long-term residential care facilities for residents, 25 studies (Table 3b; 17-22,24,26-30,32,34,38,39,42-48,50,53 ) report evidence for employee outcomes, and two studies report evidence for visitors (Table 3c; 28,47 ).…”

“…Geographically we report evidence from eleven countries, the majority (20 studies) are from USA [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and UK. [36][37][38][39][40] We report evidence from Canada, [41][42][43] France, 44,45 Hong Kong, 46,47 Belgium, 48 Germany, 49 Ireland, 50 Japan, 51 Korea, 52 and Spain 53 (Table 1).…”

“…Twenty studies report the nature of LTCFs related with outbreaks and transmission of COVID-19 infection (Table 2; 16,23,28,29,31,33,[35][36][37][38][39][41][42][43][45][46][47][50][51][52] ). Thirty studies (Table 3a; [17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34][37][38][39][40][41][42][43][45][46][47][48][49][50]53 ) report evidence of measures to ...…”

“…Morbidity and mortality results from included studies are presented for residents (Table 3a), staff (Table 3b), and visitors (Table 3c). Prevalence of COVID-19 infection was reported in 29 studies, including prevalence in residents (27 studies; [17][18][19][20][21][22][23][24][25][26][27][28][29][32][33][34]38,39,41,43,[45][46][47][48][49][50]53 ) and staff (22 studies; 17,[19][20][21][22]24,[26][27][28][29][30]32,34,38,39,[44][45][46][47][48]…”

“…positive staff, the proportion of symptomatic cases ranged from 6.4% 26 to 100%, 32 and asymptomatic cases ranged from 23.6% 50 to 100%. 20,22 Mortality results were reported in 22 studies, including information on mortality of residents (22 studies; [17][18][19][22][23][24][27][28][29]33,34,[37][38][39][40][41][42][43]45,47,49,50 ), staff (4 studies; 28,34,45,47 ), and visitors (2 studies; 28,47 ). Mortality rates in COVID-19 positive residents ranged from 5.3% 19 to 55.3%.…”