ABSTRACT
INTRODUCTION: The COVID-19 pandemic has required adaptation and implementation of innovative healthcare practices, including patient triage and limiting staff exposure. Early recognition of deteriorating patients is an imperative step in preventing adverse events, improving outcomes, and limiting unnecessary exposures. Here we describe a critical care medicine (CCM) advanced practice provider (APP) led initiative to implement remote monitoring of non-critically ill COVID-19 patients for signs of deterioration, prompt intervention, and rapid transfer to the intensive care unit (ICU). METHODS: Every admitted COVID-19 patient received an initial remote telemedicine consult by a CCM APP. Patients were then monitored via EMR review once per 12-hour shift for the following indicators: oxygen modality and flow, increase in oxygen requirements, sustained tachypnea, and hemodynamic instability (mean arterial pressure less than 65mmHg or arrhythmias). If signs of deterioration were noted, the APP would remotely reassess the patient, provide recommendations to the primary team, and/or transfer the patient to the ICU. The primary endpoint was avoidance of acute cardiopulmonary deterioration requiring aerosolgenerating procedures (AGPs) outside of the ICU. RESULTS: Over 65 days, there were 2204 total hospital admissions, of which 113 (5.1%) (86 PUIs and 27 SARSCoV- 2-positive) patients were followed by the CCM APPs. Early ICU transfer was initiated on 13 occasions (12 patients, 1 of which had 2 transfer occurrences). Of those transfers, 4 (30.8%) required intubation, 2 (15.4%) required non-invasive ventilation, and 5 (38.5%) required high flow nasal cannula, all of which occurred in negative pressure rooms within the ICU. Vasoactive support was initiated for 5 (38.5%) patients after transfer. Of the 2091 admitted patients not followed by CCM APPs, 9 (0.4%) experienced cardiopulmonary arrest outside of the ICU and 96 (4.6%) required rapid responses. Of the 113 monitored patients, 0 (0%) required rapid responses or experienced cardiopulmonary arrest or required an AGP outside of the ICU. CONCLUSIONS: An APP-led tele-monitoring program may potentially avoid unnecessary viral exposures, decrease the risk of performing emergent AGPs, optimize ICU bed elasticity, and potentially minimize preventable in-hospital mortality.