Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study

Abstract

Background Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. Objective This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. Methods This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. Results During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. Conclusions Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.

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

“…patients with COVID-19 symptoms (suspected and confirmed cases). Six of the models limited referrals to COVID-19 cases confirmed through testing [ 6 , [12] , [13] , [14] , [15] ]. The model described by Hutchings et al.…”

“…The model described by Hutchings et al. [6] excluded patients over 65 years with significant comorbidities. Shah et al.…”

“…Three examples offered patients a telephone or an app option [20] . Another example relied on the use of wearable sensors to continuously monitor temperature readings and transfer these to the medical team [6] . Twenty of the models relied on the use of pulse oximetry from the beginning of implementation, four models did not use pulse oximetry, one model added pulse oximetry three weeks after implementation and two articles indicated that the use of pulse oximetry was being considered in the near future.…”

“… [21] used a SpO 2 reading of below 93% or BP less than 90/60 mmHg. Some of the examples included in the review established safety-netting options in cases when patients could not be reached via phone such as calling the police so they could visit the patient at home [6] .…”

“…Remote home monitoring models have been implemented in the US, Australia, Canada, the Netherlands, Ireland, China and UK, with some variation in the frequency of patient monitoring, modality (a combination of telephone or video calls and use of applications or online portals), patient admission criteria, staffing used for patient monitoring and level of clinical oversight, and use of pulse oximetry [ [4] , [5] , [6] , [7] , [8] ].…”