Telehealth follow up in emergency department patients discharged with COVID-like illness and exertional hypoxia

Steel, Peter; Siegal, Jonathan; Zhang, Yiye; Cato, Kenrick; Greenwald, Peter; Melville, L.; Gogia, Kriti; Smith, Zachary; Romney, Marie Laure S.

doi:10.1016/j.ajem.2021.02.052

Cited by 10 publications

(18 citation statements)

References 19 publications

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“… 1 , 2 , 3 Protocols for and preliminary outcomes of COVID-19 patients discharged from the ED with supplemental oxygen have recently been reported. 1 , 4 , 5 , 6 A study of 194 patients with mild exertional hypoxia discharged from New York EDs with oxygen concentrators early in the pandemic found relatively low 30-day ED returns and mortality rates. 4 Outcomes of patients treated at home with supplemental oxygen have been reported; however, these studies appear to include primarily patients discharged from inpatient hospitalizations or for whom supplemental oxygen was implemented by a physician at home.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 4 , 5 , 6 A study of 194 patients with mild exertional hypoxia discharged from New York EDs with oxygen concentrators early in the pandemic found relatively low 30-day ED returns and mortality rates. 4 Outcomes of patients treated at home with supplemental oxygen have been reported; however, these studies appear to include primarily patients discharged from inpatient hospitalizations or for whom supplemental oxygen was implemented by a physician at home. 1 , 7 However, characteristics or outcomes of a large group of supplemental oxygen-requiring COVID-19 patients discharged from an ED in the United States that include varying levels of resting or exertional hypoxia have not been reported in detail in the peer-reviewed literature.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and Outcomes of 360 Consecutive COVID-19 Patients Discharged From the Emergency Department With Supplemental Oxygen

Terp

Reichert

Burner

et al. 2023

Annals of Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics and Outcomes of 360 Consecutive COVID-19 Patients Discharged From the Emergency Department With Supplemental Oxygen

Terp

Reichert

Burner

et al. 2023

Annals of Emergency Medicine

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“…Unlike some international studies of a similar nature, every case in our cohort had infection proved by polymerase chain reaction (PCR), 12 whereas direct comparison against a high-prevalence demographic is not comparable. 13 Our findings have shown that provisioning care in this model is safe, reduces burden on alternative avenues of health care, and enables quarantining of known positive cases in the comfort of their own home environment. When appropriate, patients with progressive symptoms were able to be reviewed remotely and/or in person, and receive appropriate and timely admission to hospital (including admission to hospital for end-of-life care).…”

Section: Discussionmentioning

confidence: 69%

Telehealth outpatient coronavirus disease 2019 case management at a tertiary hospital in Sydney

et al. 2021

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Introduction Coronavirus disease 2019 is an acute respiratory illness caused by severe acute respiratory syndrome coronavirus 2. The coronavirus disease 2019 pandemic upended the traditional paradigm of face-to-face provision of healthcare in the Australian context; as such, a telehealth model of active case management was implemented in our public health system, even though there was little supporting data for the safety of delivering patient care remotely to home-isolation patients in the setting of a highly infectious and potentially fatal illness. Methods A retrospective, single-centre, observational cohort study was performed over 6 weeks commencing 12 March 2020, including patients with coronavirus disease 2019 undergoing home isolation and being actively monitored by a coronavirus disease 2019 telephone assessment clinic. Outcomes assessed comprised: duration of active case follow-up, average number of telephone calls per patient, average number of hours managing each patient, treatment required including presentation to the emergency department or admission to hospital, patient characteristics and utilisation of other health services. Results Of 5223 severe acute respiratory syndrome coronavirus 2 tests performed, 170 individuals (3.25%) tested positive. A total of 158 were included: 76 (47.5%) male and median age 31 years (range 18–94). Median symptom duration was 13 days (interquartile range 6, range 2–34). Median length of coronavirus disease 2019 telephone assessment clinic admission was 10 days (interquartile range 7, range 3–32). A total of 1151 telephone patient encounters were undertaken, with a median of six phone calls made to each patient (interquartile range 5, range 1–20). Ten patients required repeat clinic review; all but one returned home. Six presented to emergency department, with three of these being admitted. In total, there were six admissions: one from the clinic, three from the emergency department and two direct from home (bypassing emergency department). Only four of the six admissions (or 2.5% of all patients) required low-flow oxygen therapy; none required high-flow oxygen or assisted ventilation. The remaining 140 patients (88.6%) were safely managed at home without complications. Discussion A telehealth model of care is safe, efficient and cost-effective for the management of mild-to-moderate coronavirus disease-19 and facilitates home isolation, especially of a low-risk population, thus providing reassurance that this model is sound and suitable for ongoing use.

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“…In a cohort of 677 patients enrolled in the program between March 29 and April 17, 2020, 86 (12.7%) patients returned to the ED and were admitted, and 16 (2.4%) required ICU level care. 8 Palliative Care Opportunity: The coalition quickly recognized the critical need for seamless integration of palliative care teams into the ED setting. The need for this was twofold: at hospitals without dedicated palliative care teams, a telemedicine solution could augment palliative care services, and ED frontline teams benefited from palliative care training specifically focused on structured "goals of care" discussions.…”

Section: Telehealth Expansion and Remote Monitoringmentioning

confidence: 99%

COVID-19 Pandemic Surge: After-Action Report of a Coalition of Emergency Departments in New York City

Tedeschi

Mills

Sharma

et al. 2021

Disaster med. public health prep.

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The COVID-19 pandemic has stressed the U.S. healthcare system in unprecedented ways. In March and April 2020, emergency departments (EDs) throughout New York City experienced high volumes and acuity related to the pandemic. Here we present a structured after-action report of a coalition of nine EDs within a hospital system in the New York City metropolitan area, with an emphasis on best practices developed during the prolonged surge as well as specific opportunities for growth. We report our experience in six key areas using a framework built around lessons learned. This report represents the most salient concepts related to our institutional after-action report, and those seemingly most relevant to our peer institutions dealing with similar circumstances.

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Telehealth follow up in emergency department patients discharged with COVID-like illness and exertional hypoxia

Cited by 10 publications

References 19 publications

Characteristics and Outcomes of 360 Consecutive COVID-19 Patients Discharged From the Emergency Department With Supplemental Oxygen

Characteristics and Outcomes of 360 Consecutive COVID-19 Patients Discharged From the Emergency Department With Supplemental Oxygen

Telehealth outpatient coronavirus disease 2019 case management at a tertiary hospital in Sydney

COVID-19 Pandemic Surge: After-Action Report of a Coalition of Emergency Departments in New York City

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