Remote home monitoring (virtual wards) during the COVID-19 pandemic: a living systematic review

ABSTRACT

ObjectivesThe aim of this review was to analyse the implementation and impact of remote home monitoring models (virtual wards) during COVID-19, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. DesignA rapid systematic review to capture an evolving evidence base. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. SettingThe review included models led by primary and secondary care across seven countries. Participants27 articles were included in the review. Main outcome measuresImpact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. ResultsThe aim of the models was to maintain patients safe in the right setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/carer training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardised reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored. ConclusionsFuture research should focus on staff and patient experiences of care and inequalities in patients access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools. Protocol registrationThe review protocol was published on PROSPERO (CRD 42020202888). RESEARCH IN CONTEXTO_ST_ABSEvidence before this studyC_ST_ABSRemote home monitoring models for other conditions have been studied, but their adaptation to monitor COVID-19 patients and the analysis of their implementation constitute gaps in research. Added value of this studyThe review covers a wide range of remote home monitoring models (pre-hospital as well as step-down wards) implemented in primary and secondary care sectors in eight countries and focuses on their implementation and impact on outcomes (including costs). Implications of all the available evidenceThe review provides a rapid overview of an emerging evidence base that can be used to inform changes in policy and practice regarding the home monitoring of patients during COVID-19. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools.