ABSTRACT
OBJECTIVES: To characterize the impact of public health interventions on the volume and characteristics of admissions to the PICU. DESIGN: Multicenter retrospective cohort study. SETTING: Six U.S. referral PICUs during February 15, 2020-May 14, 2020, compared with the same months during 2017-2019 (baseline). PATIENTS: PICU admissions excluding admissions for illnesses due to severe acute respiratory syndrome coronavirus 2 and readmissions during the same hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was admission volumes during the period of stay-at-home orders (March 15, 2020-May 14, 2020) compared with baseline. Secondary outcomes were hospitalization characteristics including advanced support (e.g., invasive mechanical ventilation), PICU and hospital lengths of stay, and mortality. We used generalized linear mixed modeling to compare patient and admission characteristics during the stay-at-home orders period to baseline. We evaluated 7,960 admissions including 1,327 during March 15, 2020-May 14, 2020. Daily admissions and patients days were lower during the period of stay-at-home orders compared with baseline: median admissions 21 (interquartile range, 17-25) versus 36 (interquartile range, 30-42) (p < 0.001) and median patient days 93.0 (interquartile range, 55.9-136.7) versus 143.6 (interquartile range, 108.5-189.2) (p < 0.001). Admissions during the period of stay-at-home orders were less common in young children and for respiratory and infectious illnesses and more common for poisonings, endocrinopathies and for children with race/ethnicity categorized as other/unspecified. There were no differences in hospitalization characteristics except fewer patients received noninvasive ventilation during the period of stay-at-home orders. CONCLUSIONS: Reductions in PICU admissions suggest that much of pediatric critical illness in younger children and for respiratory and infectious illnesses may be preventable through targeted public health strategies.
Subject(s)
COVID-19/epidemiology , Communicable Disease Control/statistics & numerical data , Intensive Care Units, Pediatric/statistics & numerical data , Patient Admission/statistics & numerical data , Adolescent , Age Factors , Child , Child, Preschool , Female , Humans , Infant , Length of Stay , Male , Pandemics , Racial Groups , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Socioeconomic Factors , Young AdultABSTRACT
Introduction and ObjectivesThe Covid-19 pandemic has driven forward a number of remote monitoring schemes (virtual wards) across the country to support the early discharge of patients with covid-19. Technology can assist clinical teams to deliver comprehensive care in the community. In this study we aim to evaluate the safety and effectiveness of an innovative, telehealth-led virtual ward for Covid-19.MethodsPatients discharged from hospital respiratory wards with a diagnosis of Covid-19 and deemed at risk of readmission (or requiring home oxygen weaning) were eligible for referral. Monitoring equipment (thermometers and digital pulse oximeters) was provided and patients were on-boarded into a telehealth platform prior to discharge. Smartphones and tablets were supplied by the service if required. A Covid-19 digital clinical question set and triaging algorithm was developed locally. Patients were instructed to complete it daily remotely during follow-up and to enter their observations three times daily. Clinical data fed into a dashboard reviewed daily by the community respiratory specialist team who would contact and assess patients submitting symptoms of concern. Monitoring lasted for up to 14 days, and escalation processes to the acute Trust were in place for those patients showing evidence of deterioration.Results218 patients were monitored between December 2020 and May 2021, 29 for oxygen weaning. 41% were female, mean age 57 years old (minimum 21, maximum 89). Average oxygen weaning time was 11 days, with 319 days of hospital bed days saved by the oxygen weaning service and an estimated £127,600 cost saving to the system. Only 10 patients (4.9%) were readmitted after 14 days (versus 9% in usual care from hospital Covid-19 wards). Four patients (1.8%) died in hospital after a readmission. 83% of patients felt ‘very supported’ by the service and 73% expressed that it had ‘fully’ improved their confidence. Average score of satisfaction with the service, measured by a self-reported questionnaire, was 9.9/10.ConclusionsA telehealth-assisted remote monitoring service for Covid-19 is a safe way to provide specialist care at home and can reduce hospital readmissions whilst improving patient experience.