Insights From Rapid Deployment of a “Virtual Hospital” as Standard Care During the COVID-19 Pandemic

Sitammagari, Kranthi; Murphy, Stephanie; Kowalkowski, Marc; Chou, Shih-Hsiung; Sullivan, Matthew F.; Taylor, Stephanie Parks; Kearns, James T.; Batchelor, Thomas; Rivet, Carly; Hole, Colleen; Hinson, Tony; McCreary, Pamela; Brown, Ryan Andrew; Dunn, Todd W.; Neuwirth, Zeev; McWilliams, Andrew

doi:10.7326/m20-4076

Cited by 110 publications

(130 citation statements)

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“…Notwithstanding the strengths of HaH, the inherent complexity of HaH poses implementation challenges 48 and several factors should be deliberated when planning such schemes. At a broad level, contextual factors for consideration include hospital location and payment structures.…”

Section: Discussionmentioning

confidence: 99%

“…These schemes can be pivotal in decentralising care, facilitating rapid ramp-ups in bed capacity, 46 and controlling nosocomial infections. 47 Notwithstanding the strengths of HaH, the inherent complexity of HaH poses implementation challenges 48 and several factors should be deliberated when planning such schemes. At a broad level, contextual factors for consideration include hospital location and payment structures.…”

Section: Recommendations For Practicementioning

confidence: 99%

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Comparison of Hospital-at-Home models: a systematic review of reviews

2021

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ObjectivesTo provide an overview of the safety and effectiveness of Hospital-at-Home (HaH) according to programme type (early-supported discharge (ESD) vs admission avoidance (AA)), and identify the model with higher evidence for addressing clinical, length of stay (LOS) and cost outcomes.MethodsA systematic review of reviews was conducted by performing a search on PubMed, EMBASE, Cochrane Database of Systematic Reviews, Web of Science and Scopus (January 2005 to June 2020) for English-language systematic reviews evaluating HaH. Data on primary outcomes (mortality, readmissions, costs, LOS), secondary outcomes (patient/caregiver outcomes) and process indicators were extracted. Quality of the reviews was assessed using Assessment of Multiple Systematic Reviews-2. There was no registered protocol.ResultsTen systematic reviews were identified (four high quality, five moderate quality and one low quality). The reviews were classified according to three use cases. ESD reviews generally revealed comparable mortality (RR 0.92–1.03) and readmissions (RR 1.09–1.25) to inpatient care, shorter hospital LOS (MD −6.76 to −4.44 days) and unclear findings for costs. AA reviews observed a trend towards lower mortality (RR 0.77, 95% CI 0.54 to 1.09) and costs, and comparable or lower readmissions (RR 0.68–0.98). Among reviews including both programme types (ESD/AA), chronic obstructive pulmonary disease reviews revealed lower mortality (RR 0.65–0.68) and post-HaH readmissions (RR 0.74–0.76) but unclear findings for resource use.ConclusionFor suitable patients, HaH generally results in similar or improved clinical outcomes compared with inpatient treatment, and warrants greater attention in health systems facing capacity constraints and rising costs. Preliminary comparisons suggest prioritisation of AA models over ESD due to potential benefits in costs and clinical outcomes. Nonetheless, future research should clarify costs of HaH programmes given the current low-quality evidence, as well as address evidence gaps pertaining to caregiver outcomes and adverse events under HaH care.

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Section: Discussionmentioning

confidence: 99%

Section: Recommendations For Practicementioning

confidence: 99%

Comparison of Hospital-at-Home models: a systematic review of reviews

2021

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“…However, it was feared that the speedy adaptation of virtualization might pose the risk of decreasing the quality of clinical care (35, 36). On the contrary, one study has shown that virtual programs may provide additional inpatient capacity during the COVID-19 pandemic (37).…”

Section: Discussionmentioning

confidence: 99%

Virtual handover of patients in the pediatric intensive care unit during COVID-19 crisis

Temsah

Abouammoh

Ashry

et al. 2021

Preprint

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Objectives: A key measure to mitigate coronavirus disease 2019 (COVID-19) has been social distancing. Incorporating video-conferencing applications in the patient handover process between healthcare workers can enhance social distancing while maintaining handover elements. This study describes pediatric intensive care unit (PICU) physicians' experience of using an online video-conferencing application for handover during the COVID-19 pandemic. Design: qualitative content analysis Setting: PICU at a university hospital in Riyadh, Saudi Arabia Subjects: PICU Physicians Interventions: Due to the pandemic, the hospital's PICU used Zoom as a remote conferencing application, instead of a face-to-face handover. Following institutional review board approval, data were collected over two weeks (July 1, 2020 to July 14, 2020). Measurements: Demographic data and narrative descriptions of the perceived efficacy of remote handover were collected using open-ended questions through a created online link. The analysis process included open coding, creating categories, and abstraction. Main Results: All 37 PICU physicians who participated in the handover completed the survey. The participants comprised six attendings, nine specialists, and 22 residents. They had variable previous teleconferencing experiences. Most physicians (78.4%) were comfortable conducting a remote endorsement. Most found that Situation-Background-Assessment-Recommendation handover elements were properly achieved through this remote handover process. The perceived advantages of online handover included fewer interruptions, time efficiency, and facilitation of social distancing. The perceived disadvantages were the paucity of nonverbal communication and teaching during virtual meetings. Conclusions: Video-conferencing applications used for online handovers could supplement traditional face-to-face intensive care unit patient endorsement during outbreaks of infectious diseases. The use of video streaming and more emphasis on teaching should be encouraged to optimize the users' experience.

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“…2 Atrium Health HaH rapidly deployed a virtual hospital model for 1,477 COVID-19 patients in early 2020, providing home hospitallevel care and monitoring through a virtual observation unit and virtual acute care unit in the home. 12 Vivify Health, which provides remote patient care through a connected care platform, published a white paper, ''Aging in Place with Remote Patient Care'' that offers advice to help health care systems and clinicians adopt telehomecare. 13 Since Johns Hopkins first piloted the hospital-at-home program 20 years ago, many hospital-based pilots for health care at home have been conducted, many ongoing.…”

Section: Telehospital Medicine Telehomecare Services and Hah Modelsmentioning

confidence: 99%