Remote patient monitoring for ED discharges in the COVID-19 pandemic

Aalam, Ahmad; Hood, Colton; Donelan, Crystal; Rutenberg, Adam; Kane, Erin M.; Sikka, Neal

doi:10.1136/emermed-2020-210022

Cited by 47 publications

(43 citation statements)

References 9 publications

(9 reference statements)

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“…The average days of home monitoring program was 10 days and this is comparable to a median length of stay of 8 days in a study from Australia [ 14 ]. In another study of 83 patients, the mean days of monitoring patients at home after discharge from emergency room was 21.8 days with an average of 14.5 daily survey responses [ 18 ]. In this study, we used the presence of comorbidities as indicator for admission at the discretion of the home monitoring team.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 home monitoring program: Healthcare innovation in developing, maintaining, and impacting the outcome of SARS-CoV-2 infected patients

Al‐Tawfiq

Kheir

Al-Dakheel

et al. 2021

Travel Medicine and Infectious Disease

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Introduction The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) had caused an increased burden on healthcare organizations. Thus, a new strategy is needed to ensure all COVID-19 positive cases are followed up appropriately, receive the proper medical and psychological support, and comply with the isolation guidelines. Here, we describe the characteristics and outcome of COVID-19 patients who were managed at home. In addition, we describe the differences between asymptomatic and those with mild symptoms. Materials and Methods This is descriptive study of all COVID-19 positive cases who were monitored utilizing the home care concept. Results During the study period from June 8 to October 18, 2020, there were a total of 5368 COVID-19 patients who were referred to the home isolation/monitoring program. Of those, 2397 (45%) were female and 2971 (55%) were male. Of the total cases, 295 (5%) required hospital admission, 45 (1%) were admitted to zone 2, and the majority 5028 (94%) were continued in the home monitoring till recovery. Of the total cases, 3137 (59%) were asymptomatic and the remaining 41% were symptomatic. Asymptomatic patients in comparison to symptomatic patients showed significant differences in relation to age, gender, being healthcare workers, and the presence of significant medical conditions. However, a logistic regression analysis showed that only age and the presence of diabetes mellitus were associated with the presence of symptoms. The mean age ( + SD) of those who required hospital admission was higher than those who were discharged or cared for in zone 2. Conclusion The utilization of home monitoring program was effective and safe in patients who were either asymptomatic or had mild symptoms.

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Section: Discussionmentioning

confidence: 99%

COVID-19 home monitoring program: Healthcare innovation in developing, maintaining, and impacting the outcome of SARS-CoV-2 infected patients

Al‐Tawfiq

Kheir

Al-Dakheel

et al. 2021

Travel Medicine and Infectious Disease

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“…Four studies did not explicitly provide the dates covered [12,14,[16][17]. All studies giving dates dealt with the early stages of the pandemic.…”

Section: Dates [The Speci C Time Period For the Reported Rpm]mentioning

confidence: 99%

“…Two rationales for RPM were evident from these published studies: COVID-19 positive patients discharged from hospital to enable safe and early discharge with on-going RPM [12,14,19,21,[23][24]; and RPM for suspected or con rmed COVID-19 patients in the community to ensure only those patients who required hospital treatment were admitted [13, 15-18, 22, 25, 26]. Only one study incorporated both [23].…”

Section: Rationale [Reasons For Implementation Of Rpm]mentioning

confidence: 99%

“…Patients were described in terms of con rmed or presumed COVID-19 positive [13,20,[23][24]26], low to moderate risk [12,21], at risk of developing serious COVID-19 [17], having symptoms of COVID-19 [15,18,22], and had or have COVID pneumonia [14,25]. The least ill patients were home quarantined suspected cases [16,18] whilst the most complex were patients who, after hospital discharge, still required oxygen therapy at home [19].…”

Section: Patients [Patients Included In Rpm]mentioning

confidence: 99%

“…One site described su cient in-house expertise to develop its own system for monitoring [12]. Some used proprietary systems from suppliers of medical monitoring systems [14-15, 18-21, 23, 26] Others adapted systems that were in use prior to COVID-19 [13,22] with the remainder using non-RPM speci c systems such as the standard telephone system or packages [17,24,25] like Zoom or WeChat (A Chinese app comparable to WhatsApp).…”

Section: Technology (Appendix 2)mentioning

confidence: 99%

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Remote Patient Monitoring for COVID-19 Patients: Comparisons and Framework for Reporting

Joyce

Brún

Symmons

et al. 2021

Preprint

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BackgroundRemote patient monitoring (RPM) has been implemented for COVID-19 patients by various health services at speed, without the opportunity to learn one from another. A lack of standardised reporting has hindered evaluation of RPM.AimsThe aims of this overview of RPM for COVID-19 patients are twofold: (1) to provide tabulated, descriptive information for a range of implementations to facilitate familiarization, learning and comparison; and based on this(2) to develop a framework for reporting to improve reporting consistency as a first step towards the development of reporting guidelines for RPM.MethodA rapid review of the literature for RPM for COVID-19 patients was conducted seeking studies that provided details of a specific implementation of RPM with sufficient information to compare one with another. The content of these articles was then reviewed and synthesised to a tabular format under common headings to facilitate ready comparison and to highlight omissions in reporting. Reporting consistencies and inconsistencies between the studies were then considered to develop a framework for reporting.ResultsThe studies suggested key common characteristics outlined under four headings: context, technology, process, and metrics. These were further divided into subheadings to provide a consistent tabular format to aid familiarization. Consideration of consistencies and inconsistencies in reporting suggests the following criteria be used for reporting: Dates, Rationale, Patients, Medical team, Technology provider, Communication mode, Patient equipment, Patient training, Staff training, Markers, Data Input Frequency, Thresholds for Escalation, Discharge and Metrics for: RPM Enrollment, Escalation, Patient acceptance, Staff acceptance, and Patient adherence.

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Remote Patient Monitoring During COVID-19

Pronovost

Cole

Hughes

2022

JAMA

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COVID-19 has placed excessive psychological and moral stress and work demands on patients, clinicians, health care organizations, and society. COVID-19 also advanced patient safety in an unexpected way. Before the COVID-19 pandemic, patient monitoring for harm and many approaches to prevent harm were linked to where the patient was treated in the hospital.A report based on data prior to the COVID-19 pandemic suggested that routinely monitoring hospitalized patients with continuous pulse oximetry and heart rate devices was associated with reduced mortality. 1 In that study, which involved 126 697 patient discharges between 2007 and 2017, early recognition of hypoxemia and respiratory depression were largely responsible for the observed decrease in mortality, from 0 deaths among 111 487 patients in monitored units vs 3 deaths among 15 209 patients in unmonitored units. Yet this surveillance system was not broadly adopted, and monitoring remains linked to location in the hospital. COVID-19 created a need to monitor patients treated in standard medical units, in emergency departments (EDs), and to also monitor some patients at home for clinical deterioration (eg, hypoxemia) to help increase hospital capacity. With the increased volume of patients coupled with high staffing ratios for all types of clinician workload, hospitalized patients are at increased risk for unrecognized clinical deterioration.Thus, patient risk, rather than physical location, should dictate the degree of monitoring. Many patients treated in general medical and surgical units and patients with COVID-19 treated at home would benefit from continuous pulse oximetry. Some individuals with COVID-19 may have died at home from unrecognized hypoxemia. A 2021 excess mortality modeling analysis estimated an additional 24% of unrecognized COVID-19attributable deaths. 2 The pandemic accelerated the move to monitoring and therapy based on patient risks and needs. A combination of medical urgency, technology advances, and payment policy supported this change. Despite many health systems reporting expanded use of monitoring, there is limited evidence regarding the incidence and prevalence of hospital unit and home monitoring, the safety and efficacy of hospital and home monitoring, and the types of patients who most benefit from which type of therapy.This Viewpoint reviews the benefits of remote monitoring in the hospital and home settings, explores the technology advances that made it possible, describes the Centers for Medicare & Medicaid Services (CMS) payment policy changes that made home monitoring sustainable, and discusses what health systems could do to launch and publish a home monitoring program.

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Remote patient monitoring for ED discharges in the COVID-19 pandemic

Cited by 47 publications

References 9 publications

COVID-19 home monitoring program: Healthcare innovation in developing, maintaining, and impacting the outcome of SARS-CoV-2 infected patients

COVID-19 home monitoring program: Healthcare innovation in developing, maintaining, and impacting the outcome of SARS-CoV-2 infected patients

Remote Patient Monitoring for COVID-19 Patients: Comparisons and Framework for Reporting

Remote Patient Monitoring During COVID-19

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