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

Abstract

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.

Patients’ and carers’ experiences of, and engagement with remote home monitoring services for COVID-19 patients: a rapid mixed-methods study

“…Earlier studies have explored types of remote home monitoring, and implementation of and cost of remote home monitoring models for COVID-19 [29][30]. Yet there was little research on patient experiences of remote home monitoring services when delivered during a pandemic; in the context of pressured health services and concerned patients.…”

“…Others referred patients onto the service as early discharges from hospital, known as COVID virtual wards [28]. See Box 1 for a brief description of services [27][28][29].…”

“…Box 1. Description of COVID-19 remote home monitoring services [27][28][29] • Patients are given a pulse oximeter, together with information and resources outlining how to use the equipment, escalation warning signs and what to do if these warning signs appear.…”

“…Whilst remote home monitoring models may reduce the need for staff to assess patients in person, they place more responsibility, commitment and workload onto patients and carers [10]. For example, in COVID-19 remote home monitoring services, patients and carers are expected to measure and record oxygen saturations, and escalate care if readings drop below certain thresholds [29][30]. This increased responsibility may be appropriate and beneficial for some patients but may not be suitable for everyone [31].…”

“…Whilst previous research indicates factors which may influence patient engagement with treatment models more generally [7,10,18,33], there is a lack of research on patient experience and engagement with remote home monitoring services for an acute condition such as COVID-19 [29][30]. If patients do not engage with these services, they may be at risk of negative outcomes that the service aimed to prevent e.g.…”