Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

Abstract

Background During the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom. Methods Norfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions. Results Between October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology. Conclusions The MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.

The Role of Digital Health in the Early Detection and Management of Obstetric Complications in the Community: A Systematic Review

“…In addition, there were also some articles discussed about short-massage service applications, mHealth technology [12], [19], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], Telemedicine [3], [20], [32], [33], [34], the use of applications [35], [36], [37], MyFitnessPal phone app [23], Mi Fit app [38], e-Moms Roc [16], WhatsApp social application [39], [40], SEESPA [41], RapidSMS [42], E screening [43], [44], PEARS [28], [45], and Cellular-enabled glucometers [46]. Others were about watch-based applications and video conferencing like using a smartwatch [47], Telehealth: video conference [45], [48], [49], flexible maternity virtual ward services [50], internet-based [24], [51], website Williamson [52], and Text or voice message [53].…”

Telemedicine in specialist outpatient care during COVID‐19: a qualitative study

“…Clinicians' mixed views on telemedicine are echoed in other global and Australian studies 27–30 . Advances in remote assessments of patients in surgical disciplines suggest that some diagnostic and assessment challenges can be addressed, assisted by guidance documents, technical innovations and digital literacy 3,31–39 . However, most clinicians largely favoured in‐person consultations for many clinical problems, citing the value of physical cues 40,41 .…”

Evaluation of a virtual ward model of care and readmission characteristics during the COVID‐19 pandemic within an Australian tertiary hospital

“…Previous studies have highlighted the effectiveness of the VW model in the antenatal cohort, but further analyses are required to identify predictors of deterioration and more adept triage criteria within this population. 22 Of the 27 patients who were readmitted to medical wards, 19 were admitted for reasons related to COVID-19, while the remaining eight were admitted for reasons not related to COVID-19. It is reasonable to assume that some of these non-COVID-19 admissions (falls, diabetic ketoacidosis and atrial fibrillation) were indirectly related to the underlying COVID-19 diagnosis.…”

“…Twenty‐one patients were readmitted for antenatal complications. Previous studies have highlighted the effectiveness of the VW model in the antenatal cohort, but further analyses are required to identify predictors of deterioration and more adept triage criteria within this population 22 . Of the 27 patients who were readmitted to medical wards, 19 were admitted for reasons related to COVID‐19, while the remaining eight were admitted for reasons not related to COVID‐19.…”