Telehealth outpatient coronavirus disease 2019 case management at a tertiary hospital in Sydney

Abstract

Introduction Coronavirus disease 2019 is an acute respiratory illness caused by severe acute respiratory syndrome coronavirus 2. The coronavirus disease 2019 pandemic upended the traditional paradigm of face-to-face provision of healthcare in the Australian context; as such, a telehealth model of active case management was implemented in our public health system, even though there was little supporting data for the safety of delivering patient care remotely to home-isolation patients in the setting of a highly infectious and potentially fatal illness. Methods A retrospective, single-centre, observational cohort study was performed over 6 weeks commencing 12 March 2020, including patients with coronavirus disease 2019 undergoing home isolation and being actively monitored by a coronavirus disease 2019 telephone assessment clinic. Outcomes assessed comprised: duration of active case follow-up, average number of telephone calls per patient, average number of hours managing each patient, treatment required including presentation to the emergency department or admission to hospital, patient characteristics and utilisation of other health services. Results Of 5223 severe acute respiratory syndrome coronavirus 2 tests performed, 170 individuals (3.25%) tested positive. A total of 158 were included: 76 (47.5%) male and median age 31 years (range 18–94). Median symptom duration was 13 days (interquartile range 6, range 2–34). Median length of coronavirus disease 2019 telephone assessment clinic admission was 10 days (interquartile range 7, range 3–32). A total of 1151 telephone patient encounters were undertaken, with a median of six phone calls made to each patient (interquartile range 5, range 1–20). Ten patients required repeat clinic review; all but one returned home. Six presented to emergency department, with three of these being admitted. In total, there were six admissions: one from the clinic, three from the emergency department and two direct from home (bypassing emergency department). Only four of the six admissions (or 2.5% of all patients) required low-flow oxygen therapy; none required high-flow oxygen or assisted ventilation. The remaining 140 patients (88.6%) were safely managed at home without complications. Discussion A telehealth model of care is safe, efficient and cost-effective for the management of mild-to-moderate coronavirus disease-19 and facilitates home isolation, especially of a low-risk population, thus providing reassurance that this model is sound and suitable for ongoing use.

A new approach to digital health? Virtual COVID-19 care: A scoping review

“…Symptom monitoring and assessment were the most common type of service in the virtual care basket, addressing the biomedical needs. Nine studies implemented a system to identify the risk and urgency based on the clinical presentation of participants such as a red-amber-green rating, 35 higher-risk and lower-risk classification 25 , 26 , 28 , 32 , 34 , 36 , 39 and symptom severity, 38 which affected the frequency or timeliness of contacts with the health provider, or care model. While the monitoring of vital signs and bio-signals was offered by several studies, Michaud et al 31 in particular, tested the feasibility of a self-assessment and self-monitoring model whereby participants themselves autonomously seek medical care based on a severity algorithm provided by the study.…”

“… 43 Eleven studies also offered dedicated helplines, contact information, or similar safety system, whereby the patient can reach a provider directly, or message or page a provider when needed. 26 , 28 , 29 , 32 , 34 , 36 , 39 , 40 , 42 , 43 Notably, research conducted in Australia and UK highlighted the use of “virtual wards” as an extended hospital service, using inpatient language such as admissions and bed days. 28 , 30 , 35 However, these wards did not involve inpatient face-to-face admission; rather the ward provided virtual care remotely to patients in their homes or usual dwelling in the community.…”

“… 25 , 31 , 33 Other studies did not specify time frame parameters, where discharge relied for example, on symptom resolution, isolation clearance, or clinician judgment about recovery. 26 , 28 – 30 , 32 , 34 , 35 , 37 , 39 , 41 , 43 Figure 2 summarizes the duration of virtual care.…”

“… 27 , 29 , 32 , 33 Distribution of pulse oximeters and thermometers to patients isolating at home was also common. 27 , 29 , 32 , 33 , 36 Telemedicine or telehealth provided solely through telephone calls (without any other equipment) was the mode of health care delivery in five studies., 25 , 26 , 28 , 30 , 38 Usage of digital applications designed for health care, such as the digital platforms with patient and clinician portals were used. 33 , 35 For example, Swift et al 35 operated a virtual ward through a digital platform where patients could enter information which were then transmitted and displayed on the clinical dashboard for clinician monitoring.…”

Evaluation of the E-Mental Health Mindfulness-Based and Skills-Based “CoPE It” Intervention to Reduce Psychological Distress in Times of COVID-19: Results of a Bicentre Longitudinal Study

“…During the ongoing pandemic, new and digital patient care approaches (e.g., telerehabilitation) were rapidly established. These approaches have proven to be highly accepted, satisfying and feasible expansions to medical care (30)(31)(32)(33)(34)(35). Regarding e-mental health approaches to face pandemic related distress there is only limited evidence.…”