A virtual care program for outpatients diagnosed with COVID-19: a feasibility study

Abstract

I n December 2019, an outbreak of acute respiratory illness secondary to a novel coronavirus (SARS-CoV-2) originated in Wuhan, China. As of May 13, 2020, coronavirus disease 2019 (COVID-19) has caused a global pandemic resulting in more than 4 170 000 cases and over 287 000 deaths. 1 This pandemic has placed immense, and in some cases overwhelming, strain on health care systems around the world. Most people with COVID-19 present initially with a mild illness and do not require hospital admission. 2 These patients are generally discharged home to self-isolation as a means of reducing the burden on the health care system and limiting spread of COVID-19 to other, vulnerable patients and staff in hospital. 3 We expected, however, that, owing to self-isolation requirements, there would be no formal method for physician assessments or counselling to occur in outpatients whose tests subsequently return as positive for COVID-19. The aim of our study was to develop and test the feasibility of a virtual care program for physician assessment and follow-up of outpatients with COVID-19 in self-isolation. Methods Design and setting Sunnybrook Health Sciences Centre is a 627-bed academic tertiary care centre located in Toronto, Ontario. Patients who present to our institution with suspected COVID-19 infection and mild symptoms are sent home to self-isolate while test results are pending. Institutional testing criteria for COVID-19 have evolved throughout the pandemic. Early in the pandemic, criteria for testing focused on patients with respiratory symptoms and a compatible history of travel to a high-risk country within the preceding 14 days. With ongoing local

Transition to virtual appointments for interventional neuroradiology due to the COVID-19 pandemic: a survey of satisfaction

“…1 In an effort to practice physical distancing, many specialties have moved routine patient encounters to telephone and virtual platforms. [2][3][4] These changes may not be temporary.…”

Feasibility of the home isolation programme for adults and children with COVID-19

“…The conclusions from the former study were similar to our findings that such programmes can be used for the management of noncritical patients. 10 In our study, the positive feature was that monitoring for hypoxia which is the most vital parameter was done daily in patients. Thus, it was easy for doctors and patients themselves to assess for hypoxia and seek medical care immediately.…”

Home or Cabin

“…7 In North America and Europe, however, a more common approach to treating patients with mild-to-moderate COVID-19 has been home isolation, with remote physician monitoring by telephone or virtual care platforms. [8][9][10] The advantages of remote virtual monitoring include ease and speed of implementation, lower costs, and allowing patients to stay in the comfort of their home. 9 However, the incremental labor and costs associated with mobile cabin hospitals could be worthwhile if they can (1) provide safer oversight of at-risk patients and/or (2) decrease community transmission of COVID-19.…”

“…In the Dongxihu mobile cabins, 14% of patients required transfer to acute care, 3 which is similar to the rate of hospital transfer that has been documented in a home virtual care assessment model. 10 Further comparisons are required to determine if the mobile cabin model, with its additional oversight but higher resource utilization, reduces clinically relevant outcomes.…”

“…Alternative options, including virtual care assessments while maintaining patients at home, have also been implemented at various centers around the world. 9,10 Although there are potential advantages to the mobile cabin strategy, further comparative research is required to assess the (1) impact on clinical outcomes such as hospitalization, ICU admission, and death, (2) reduction in household transmission, (3) cost-effectiveness, and (4) potential unintended consequences such as transmission to health care workers, over-medicalization of those with mild-to-moderate viral infection, and psychologic distress of institutionalization.…”