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Hicks N, Zhan J, Brual J, Abejirinde IOO, Alfred M. Escalation Pathways of Remote Patient Monitoring Programs for COVID-19 Patients in Canada and the United States: A Rapid Review. Telemed J E Health 2024. [PMID: 39269888 DOI: 10.1089/tmj.2024.0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024] Open
Abstract
Introduction: During the COVID-19 pandemic, hospitals in North America were overwhelmed with COVID-19 patients and had limited capacity to admit patients. Remote patient monitoring (RPM) programs were developed to monitor COVID-19 patients at home and reduce disease transmission and the demand on hospitals. A critical component of RPM programs is effective escalation pathways. The purpose of this review is to synthesize the implementation of escalation pathways of RPM programs for COVID-19 patients in Canada and the United States. Methods: The search identified 563 articles from Embase, PubMed, and Scopus. Following title and abstract screening, 131 were selected for full-text review, and 26 articles were included. Data were extracted on study location, patient eligibility and program size, data collection, monitoring team, escalation criteria, and escalation response. Results: The included studies were published between 2020 and 2022; 3 in Canada and 23 in the United States. The RPM programs collected physiological vital signs and symptom data, which were inputted manually by patients and health care workers or synced automatically. Escalations were triggered automatically or following manual review by nurses and physicians when signs and symptoms were concerning or reached a specific threshold. Escalations included emergency department referrals, physician appointments, and increased monitoring. Conclusion: Many decisions are required when designing RPM escalation pathways for patients with COVID-19, which is crucial to promptly address patients' changing health statuses and clinical needs. Future research is needed to evaluate the effectiveness of escalation pathways for COVID-19 patients through performance metrics and patient and health care worker experience.
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Affiliation(s)
- Nicole Hicks
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Jingjing Zhan
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Janette Brual
- Research and Innovation Institute, Women's College Hospital, Toronto, Canada
| | - Ibukun-Oluwa Omolade Abejirinde
- Research and Innovation Institute, Women's College Hospital, Toronto, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Myrtede Alfred
- Department of Mechanical and Industrial Engine, University of Toronto, Toronto, Canada
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2
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Bann M, Manjarrez E, Kellner CP, Greysen R, Davis C, Lee T, Soleimanpour N, Tambe N, Auerbach A, Schnipper JL. Post-Hospitalization Home Monitoring Programs During the COVID-19 Pandemic: Survey Results from the Hospital Medicine Re-engineering Network (HOMERuN). J Gen Intern Med 2024; 39:1288-1293. [PMID: 38151604 PMCID: PMC11169426 DOI: 10.1007/s11606-023-08581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, hospitals and healthcare systems launched innovative responses to emerging needs. The creation and use of programs to remotely follow patient clinical status and recovery after COVID-19 hospitalization has not been thoroughly described. OBJECTIVE To characterize deployment of remote post-hospital discharge monitoring programs during the COVID-19 pandemic METHODS: Electronic surveys were administered to leaders of 83 US academic hospitals in the Hospital Medicine Re-engineering Network (HOMERuN). An initial survey was completed in March 2021 with follow-up survey completed in July 2022. RESULTS There were 35 responses to the initial survey (42%) and 15 responses to the follow-up survey (43%). Twenty-two (63%) sites reported a post-discharge monitoring program, 16 of which were newly developed for COVID-19. Physiologic monitoring devices such as pulse oximeters were often provided. Communication with medical teams was often via telephone, with moderate use of apps or electronic medical record integration. Programs launched most commonly between January and June 2020. Only three programs were still active at the time of follow-up survey. CONCLUSIONS Our findings demonstrate rapid, ad hoc development of post-hospital discharge monitoring programs during the COVID-19 pandemic but with little standardization or evaluation. Additional study could identify the benefits of these programs, instruct their potential application to other disease processes, and inform further development as part of emergency preparedness for upcoming crises.
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Affiliation(s)
- Maralyssa Bann
- University of Washington School of Medicine, Seattle, WA, USA.
- Division of GIM/Hospital Medicine, Harborview Medical Center, Seattle, WA, USA.
| | - Efren Manjarrez
- Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | | | - Ryan Greysen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Clark Davis
- Brigham and Women's Hospital, Boston, MA, USA
| | - Tiffany Lee
- University of California San Francisco, San Francisco, CA, USA
| | | | - Neal Tambe
- University of California San Francisco, San Francisco, CA, USA
| | - Andrew Auerbach
- University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey L Schnipper
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Aledia AS, Dangodara AA, Amin AA, Amin AN. Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study. J Med Internet Res 2024; 26:e55623. [PMID: 38754103 PMCID: PMC11140270 DOI: 10.2196/55623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist. OBJECTIVE We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic. METHODS This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient). RESULTS There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels. CONCLUSIONS An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value.
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Affiliation(s)
- Anna S Aledia
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Amish A Dangodara
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Aanya A Amin
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
| | - Alpesh N Amin
- Department of Medicine & Hospital Medicine, University of California, Irvine, Orange, CA, United States
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Fried S, Bar-Shai A, Frydman S, Freund O. Transition of care interventions to manage severe COVID-19 in the ambulatory setting: a systematic review. Intern Emerg Med 2024; 19:765-775. [PMID: 38104299 DOI: 10.1007/s11739-023-03493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Severe COVID-19, with the need in supplemental oxygen and hospitalization, leads to major burden on patients and healthcare systems. As a result, safe and effective ambulatory treatment strategies for severe COVID-19 are of urgent need. In this systematic review, we aimed to evaluate interventions to transition care to the ambulatory setting for patients with active severe COVID-19 that required supplemental oxygen. METHODS We searched Medline, Scopus, Web of Science, and DOAJ databases to identify articles with original data published until the 1st of April 2023. Characteristics and outcomes of interventions to transition care to home management were reviewed. Given the heterogeneous settings and outcomes studied, a meta-analysis was not performed. RESULTS Of the 235 studies identified, 11 observational studies, with 2645 patients, were included. The interventions were initiated from the emergency department, observation units or inpatient units, and included continuous home telemonitoring (n = 8), mobile applications (n = 2), and patient-initiated medical contact (n = 3). Included patients had an overall short length of hospital stay, high readmission rates, and positive patients' feedback. There was a lack of prospective controlled data and cost-effectiveness analyses. CONCLUSION Our findings highlight the potential in treating severe COVID-19 at the ambulatory setting and the lack of high-quality data in this field. Dedicated medical teams, adjusted monitoring methods, improving clinical trajectory, and correct inclusion settings are needed for safe and effective transition of care.
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Affiliation(s)
- Sabrina Fried
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Amir Bar-Shai
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel
| | - Shir Frydman
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel
| | - Ophir Freund
- The Institute of Pulmonary Medicine, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel-Aviv, Israel.
- Internal Medicine B, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Weizmann 6, Tel-Aviv, Israel.
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Hänninen J, Anttalainen U, Kilpeläinen M, Hohenthal U, Broman N, Palmén J, Oksi J, Feuth T. Rapid implementation of home oxygen treatment and remote monitoring for COVID-19 patients at the verge of the Omicron wave in Turku, Finland. BMC Infect Dis 2023; 23:799. [PMID: 37968593 PMCID: PMC10647078 DOI: 10.1186/s12879-023-08825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND In Turku, Finland, we introduced a home oxygen treatment and app-based monitoring program for hospitalized COVID-19 patients to facilitate an early discharge during the Omicron wave. In this case series we explore the clinical parameters of patients enrolled in the program and evaluate the cost-benefit and safety issues of the program. METHODS Hospitalized COVID-19 patients with marked hypoxemia but otherwise in stable condition were screened from Turku City Hospital and Turku University Hospital by treating doctors for eligibility in the program. Peripheral oxygen saturation of > 92% and breathing frequency < 30/min in rest with oxygen supplementation were among the criteria. All patients actively participating in the program between 10th of January 2022 and 30th of September 2022 were included in this case series. Clinical data of hospitalization and monitoring were analysed, and cost-benefit evaluation was based on the number of saved hospitalization days. RESULTS Nineteen COVID-19 patients were included in this case series and recruited from three different hospital departments in the Turku city region, South-West Finland. All patients were male, the median age was 59 years and the median duration of hospitalization before enrolment in the program was 6 days (range 3-20 days). The median duration of home oxygen treatment was 13 days (range 3-72 days) and the median duration of home monitoring was 18 days (range 7-41 days). A total of 210,5 hospital days were prevented, resulting in savings of €144,490 of healthcare expenditure (on average 9 days and €7,605 per patient). No major safety issues were reported during the program. CONCLUSIONS In our case series, home oxygen treatment combined with home monitoring was safe and economically beneficial. Application based monitoring could be considered in other post-acute pulmonary conditions to reduce hospitalization and healthcare costs.
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Affiliation(s)
- Janne Hänninen
- Department of Pulmonary Diseases and Allergology, Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Ulla Anttalainen
- Department of Pulmonary Diseases and Allergology, Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Maritta Kilpeläinen
- Department of Pulmonary Diseases and Allergology, Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Ulla Hohenthal
- Department of Infectious Diseases, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Jenni Palmén
- Department of Pulmonary Diseases and Allergology, Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Department of Infectious Diseases, University of Turku and Turku University Hospital, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, University of Turku and Turku University Hospital, Turku, Finland
| | - Thijs Feuth
- Department of Pulmonary Diseases and Allergology, Division of Medicine, University of Turku and Turku University Hospital, Turku, Finland.
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Iqbal MP, Newman B, Ellis LA, Mears S, Harrison R. Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107922. [PMID: 37542823 DOI: 10.1016/j.pec.2023.107922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care. METHODS A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models. CONCLUSION Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.
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Affiliation(s)
- Maha Pervaz Iqbal
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Mears
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Dugani SB, Kiliaki SA, Nielsen ML, Fischer KM, Lunde M, Kesselring GM, Lawson DK, Coons TJ, Schenzel HA, Parikh RS, Pagali SR, Liwonjo A, Croghan IT, Schroeder DR, Burton MC. Postdischarge Video Visits for Adherence to Hospital Discharge Recommendations: A Randomized Clinical Trial. MAYO CLINIC PROCEEDINGS. DIGITAL HEALTH 2023; 1:368-378. [PMID: 37641718 PMCID: PMC10460477 DOI: 10.1016/j.mcpdig.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Objective To determine whether a postdischarge video visit with patients, conducted by hospital medicine advanced practice providers, improves adherence to hospital discharge recommendations. Patients and Methods We conducted a single-institution 2-site randomized clinical trial with 1:1 assignment to intervention vs control, with enrollment from August 10, 2020, to June 23, 2022. Hospital medicine patients discharged home or to an assisted living facility were randomized to a video visit 2-5 days postdischarge in addition to usual care (intervention) vs usual care (control). During the video visit, advanced practice providers reviewed discharge recommendations. Both intervention and control groups received telephone follow-up 3-6 days postdischarge to ascertain the primary outcome of adherence to all discharge recommendations for new and chronic medication management, self-management and action plan, and home support. Results Among 1190 participants (594 intervention; 596 control), the primary outcome was ascertained in 768 participants (314 intervention; 454 control). In intervention vs control, there was no difference in the proportion of participants with the primary outcome (76.7% vs 72.5%; P=.19) or in the individual domains of the primary outcome: new and chronic medication management (94.1% vs 92.8%; P=.50), self-management and action plan (76.5% vs 71.5%; P=.18), and home support (94.1% vs 94.3%; P=.94). Women receiving intervention vs control had higher adherence to recommendations (odds ratio, 1.77; 95% CI, 1.08-2.91). Conclusion In hospital medicine patients, a postdischarge video visit did not improve adherence to discharge recommendations. Potential gender differences in adherence require further investigation.Clinicaltrials.gov number, NCT04547803.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Shangwe A Kiliaki
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Megan L Nielsen
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Karen M Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Megan Lunde
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Gina M Kesselring
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Donna K Lawson
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Trevor J Coons
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Holly A Schenzel
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Riddhi S Parikh
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Sandeep R Pagali
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
| | - Anne Liwonjo
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Lake City, MN
| | - Ivana T Croghan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of General Internal Medicine; Department of Medicine, Clinical Research Office; Mayo Clinic, Rochester, MN
| | | | - M Caroline Burton
- Division of Hospital, Internal Medicine, Mayo, Clinic, Rochester, MN
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Joyce D, De Brún A, Symmons SM, Fox R, McAuliffe E. Remote patient monitoring for COVID-19 patients: comparisons and framework for reporting. BMC Health Serv Res 2023; 23:826. [PMID: 37537615 PMCID: PMC10401771 DOI: 10.1186/s12913-023-09526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND COVID-19 has challenged health services throughout the world in terms of hospital capacity and put staff and vulnerable populations at risk of infection. In the face of these challenges, many health providers have implemented remote patient monitoring (RPM) of COVID-19 patients in their own homes. However systematic reviews of the literature on these implementations have revealed wide variations in how RPM is implemented; along with variations in particulars of RPM reported on, making comparison and evaluation difficult. A review of reported items is warranted to develop a framework of key items to enhance reporting consistency. The aims of this review of remote monitoring for COVID-19 patients are twofold: (1) to facilitate comparison between RPM implementations by tabulating information and values under common domains. (2) to develop a reporting framework to enhance reporting consistency. METHOD A review of the literature for RPM for COVID-19 patients was conducted following PRISMA guidelines. The Medline database was searched for articles published between 2020 to February 2023 and studies reporting on items with sufficient detail to compare one with another were included. Relevant data was extracted and synthesized by the lead author. Quality appraisal was not conducted as the the articles considered were evaluated as informational reports of clinical implementations rather than as studies designed to answer a research question. RESULTS From 305 studies retrieved, 23 studies were included in the review: fourteen from the US, two from the UK and one each from Africa, Ireland, China, the Netherlands, Belgium, Australia and Italy. Sixteen generally reported items were identified, shown with the percentage of studies reporting in brackets: Reporting Period (82%), Rationale (100%), Patients (100%), Medical Team (91%) Provider / Infrastructure (91%), Communications Platform (100%), Patient Equipment (100%), Training (48%), Markers (96%), Frequency of prompt / Input (96%),Thresholds (82%), Discharge (61%), Enrolled (96%), Alerts/Escalated (78%), Patient acceptance (43%), and Patient Adherence (52%). Whilst some studies reported on patient training and acceptance, just one reported on staff training and none on staff acceptance. CONCLUSIONS Variations in reported items were found. Pending the establishment of a robust set of reporting guidelines, we propose a reporting framework consisting of eighteen reporting items under the following four domains: Context, Technology, Process and Metrics.
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Affiliation(s)
- David Joyce
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Aoife De Brún
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Sophie Mulcahy Symmons
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Robert Fox
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland
| | - Eilish McAuliffe
- Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, D04 V1W8, Ireland.
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Maleque NM, Hartigan S, Merchant N. Finding your niche as a generalist: From concept to action. J Hosp Med 2023; 18:270-273. [PMID: 36564957 DOI: 10.1002/jhm.13034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Noble M Maleque
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah Hartigan
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Naseema Merchant
- Department of Medicine, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, USA
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van den Berg R, Meccanici C, de Graaf N, van Thiel E, Schol-Gelok S. Starting Home Telemonitoring and Oxygen Therapy Directly after Emergency Department Assessment Appears to Be Safe in COVID-19 Patients. J Clin Med 2022; 11:7236. [PMID: 36498810 PMCID: PMC9736754 DOI: 10.3390/jcm11237236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Since data on the safety and effectiveness of home telemonitoring and oxygen therapy started directly after Emergency Department (ED) assessment in COVID-19 patients are sparse but could have many advantages, we evaluated these parameters in this study. METHODS All COVID-19 patients ≥18 years eligible for receiving home telemonitoring (November 2020-February 2022, Albert Schweitzer hospital, the Netherlands) were included: patients started directly after ED assessment (ED group) or after hospital admission (admission group). Safety (number of ED reassessments and hospital readmissions) and effectiveness (number of phone calls, duration of oxygen usage and home telemonitoring) were described in both groups. RESULTS 278 patients were included (n = 65 ED group, n = 213 admission group). ED group: 23.8% (n = 15) was reassessed, 15.9% (n = 10) was admitted and 7.7% (n = 5) ICU admitted. Admission group: 15.8% (n = 37) was reassessed, 6.5% (n = 14) was readmitted and 2.4% (n = 5) ICU (re)admitted. Ten patients died, of whom 7 due to COVID-19 (1 in ED group; 6 in the admission group). ED group: median duration of oxygen therapy was 9 (IQR 7-13) days; the total duration of home telemonitoring was 14 (IQR 9-18) days. Admission group: duration of oxygen therapy was 10 (IQR 6-16) days; total duration of home telemonitoring was 14 (IQR 10-20) days. CONCLUSION it appears to be safe to start home telemonitoring and oxygen therapy directly after ED assessment.
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Affiliation(s)
- Rosaline van den Berg
- Science Office, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Celisa Meccanici
- Emergency Department, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Netty de Graaf
- Department of Pulmonology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Eric van Thiel
- Department of Pulmonology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
| | - Suzanne Schol-Gelok
- Emergency Department, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands
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