Safety and effectiveness of an integrated, telehealth-led supported discharge service for Covid-19

ABSTRACT

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.