ABSTRACT
Aim: This work aims to evaluate the safety and utility of an at-home telemedicine with telemonitoring program for discharged COVID-19 patients. Methods: This is a retrospective cohort study of all patients discharged home in Galicia between 6 March 2020 and 15 February 2021. We evaluated a structured, proactive monitoring program conducted by the ASLAM (Área Sanitaria de Lugo, A Mariña y Monforte de Lemos) Healthcare Area team compared to patients discharged in the rest of the Autonomous Community of Galicia. Results: During the study period, 10,517 patients were hospitalized for COVID-19 and 8601 (81.8%) were discharged. Of them, 738 (8.6%) were discharged in ASLAM and 7863 (91.4%) were discharged in the rest of Galicia. Of those discharged in ASLAM, 475 (64.4%) patients were monitored. Compared to patients in the rest of Galicia, the group monitored via telemedicine had a significantly shorter first hospital stay (p < 0.0001), a lower readmission rate (p = 0.05), and a shorter second hospital stay (p = 0.04), with no differences in emergency department visits or 90-day all-cause mortality. Conclusion: A structured, proactive telemedicine with telemonitoring program for discharged COVID-19 patients is a safe, useful tool that reduces the mean length of hospital stay and readmissions.
ABSTRACT
AIM: this work aims to assess if telemedicine and telemonitoring are clinically useful and safe for at-home monitoring of Coronavirus disease 2019 (COVID-19) patients. METHODS: This is a retrospective cohort study of all patients diagnosed with COVID-19 in Galicia (Northwestern Spain) between 26 December 2020 and 15 February 2021. The structured, proactive monitoring via telemonitoring (TELEA) of patients considered to be high-risk in the Lugo, A Mariña, and Monforte Healthcare Area (ASLAM) was evaluated compared to other models in the remaining healthcare areas of Galicia. RESULTS: Of the 47,053 COVID-19 patients, 4384 (9.3%) were in ASLAM. Of them, 1187 (27.1%) were monitored via TELEA, and the rest (3197 in ASLAM and 42,669 in the rest of Galicia) were monitored via other methods. Patients monitored in ASLAM via TELEA were older, consulted in the emergency department less frequently (p = 0.05), were hospitalized less frequently (p < 0.01), had shorter hospital stays (p < 0.0001), and had a lower mortality rate in their first hospitalization (p = 0.03). No at-home life-threatening emergencies were recorded. CONCLUSIONS: these data suggest that, for COVID-19 patients, a care model involving proactive at-home monitoring with telemedicine and telemonitoring is associated with reduced pressure on hospital services and a lower mortality rate.
ABSTRACT
OBJETIVO: Evaluar el efecto de una intervención formativa realizada por enfermeras en pacientes crónicos complejos durante el ingreso hospitalario en un servicio de Medicina Interna. MÉTODO: Ensayo clínico pragmático de una intervención educativa de enfermeras frente a la actuación habitual. Para el grupo de intervención se diseñó un plan de educación en cuidados, personalizado para cada paciente, en función de las necesidades detectadas en una primera entrevista. La intervención se extendió durante el tiempo del ingreso y se dispuso de un teléfono de contacto al alta para la resolución de dudas. RESULTADOS: De entre los 498 pacientes seleccionados inicialmente fueron excluidos 131 por no cumplir los criterios para ser considerados pacientes crónicos complejos o por no detectarse deficiencias en su formación o sus cuidados. Un paciente (0,20%) no aceptó participar y no hubo abandonos. De los 366 participantes, 190 se integraron en el grupo de intervención y 176 en el control. En los primeros 8 días tras el alta, reingresaron 2 (1,05%) pacientes del grupo de intervención y 8 (4,54%) del grupo control (p = 0,05). En los primeros 30 días tras el alta reingresaron 26 (13,70%) y 33 (18,75%), respectivamente (p = 0,10). CONCLUSIONES: Este estudio muestra como una intervención educativa por enfermeras en pacientes crónicos complejos, realizada durante el ingreso hospitalario en unidades de Medicina Interna, puede reducir los reingresos a corto plazo
OBJECTIVE: To evaluate whether a training intervention performed by nursing professionals in complex chronic patients, during hospitalisation in an internal medicine service, can modify the pattern of readmissions or reduce their number. METHOD: Pragmatic clinical trial of a nursing training intervention vs. habitual performance. For the intervention group, a training plan in care was designed, personalised for each patient, according to the needs detected in a first interview. The intervention was extended during the time of admission and a contact phone was available after discharge to resolve doubts. RESULTS: Among the 498 patients interviewed initially, 131 were excluded because they were not a complex chronic patient or because they found no deficiencies in their training or care. One patient (.20%) did not agree to participate and there were no dropouts. Of the 366 participants, 190 were included in the intervention group and 176 in the control group. In the first 8 days after discharge, 2 (1.05%) patients from the intervention group and 8 (4.54%) from the control group were re-admitted (p=.05). In the first 30 days after discharge, 26 patients (13.70%) and 33 patients (18.75%) respectively (p=.10) were readmitted. CONCLUSIONS: This study shows how a nursing training intervention during hospitalisation in Internal Medicine in complex chronic patients reduces short-term readmissions
Subject(s)
Humans , Male , Aged , Evaluation of the Efficacy-Effectiveness of Interventions , Chronic Disease/nursing , Hospitalization , Education, Nursing/methods , Patient Readmission , Patient Readmission/statistics & numerical data , Nursing Research , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate whether a training intervention performed by nursing professionals in complex chronic patients, during hospitalisation in an internal medicine service, can modify the pattern of readmissions or reduce their number. METHOD: Pragmatic clinical trial of a nursing training intervention vs. habitual performance. For the intervention group, a training plan in care was designed, personalised for each patient, according to the needs detected in a first interview. The intervention was extended during the time of admission and a contact phone was available after discharge to resolve doubts. RESULTS: Among the 498 patients interviewed initially, 131 were excluded because they were not a complex chronic patient or because they found no deficiencies in their training or care. One patient (.20%) did not agree to participate and there were no dropouts. Of the 366 participants, 190 were included in the intervention group and 176 in the control group. In the first 8 days after discharge, 2 (1.05%) patients from the intervention group and 8 (4.54%) from the control group were re-admitted (p=.05). In the first 30 days after discharge, 26 patients (13.70%) and 33 patients (18.75%) respectively (p=.10) were readmitted. CONCLUSIONS: This study shows how a nursing training intervention during hospitalisation in Internal Medicine in complex chronic patients reduces short-term readmissions.
