Coronavirus and Hospital at Home: What’s Our Role?

20 Comments

1. Coronavirus is a major outbreak putting at risk both doctors and patients.

   Can Hospital at Home model be used to help reduce the risk? Can we use technology to monitor some of the patients from home, test them, limit physical interaction to stop the spread of the disease? Do you have the tools to do that in your organization?

   Share your opinions and experience so far!

• Hi! We want to share with you a few materials we’ve found on the topic:

  Coronavirus: home testing pilot launched in London to cut hospital visits and ambulance use
  https://www.bmj.com/content/368/bmj.m621

  Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (2019-nCoV)
  https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html

  https://www.mobihealthnews.com/news/asia-pacific/celcom-partners-malaysia-based-digital-health-platform-doctoroncall

  We look forward to receiving your comments!

• Using medical grade wearables (FDA-cleared) for the quarantined patients monitoring is only way to .minimize risks of health care workers:

  https://www.linkedin.com/pulse/minimizing-risks-health-care-workers-during-corona-leon-eisen-phd/?trackingId=Q20c6rXBT3qDZxlphdnspg

2. I work as a doctor at the Torrejon Hospital (Madrid, Spain) Hospital at Home service, one of the first hospital affected by the coronavirus crisis in my country.
   From the begining of this crisis, hospital managers thought that the hospital at home unit was an essencial strategy to reduce hospital overload.
   We have desinged an early discharge plan for patients affected by the coronavirus. This plan includes patients with pneumonia improving after 48h of admission.
   The criteria for being admitted in HaH unit include:
   – Baseline SatO2 > 90%
   – Respiratory rate < 24 pm
   – Heart rate < 100 bpm - Systolic bood pressure >90 mmHg
   – Axilar temperatura < 37.2ºC (this criterion could be revised because we have observed that some febril patients are in an excellent clinical condition).
   – Stable neurological status
   – Improving, (not severe) transaminases and LDH levels
   – Improving (not severe) lymphopenia levels
   – Improving C-reactive protein levels
   – Ability and commitment of both patient and caregiver for understanding and aplying estrict isolation measures at home.
   – General HaH criteria
   Since March 6th, we have admitted 19 patients at our HaH unit, with different ages, conditions and severity. Three have already been discharged, and 16 remain admitted. Up to now none of them have been readmitted due to complications or clinical worsening.
   I hope this could be a useful information for this community and I encourage to share more experiences.
   Manuel Mirón

• Manuel
  Thanks a lot for sharing this important and professional information.
  We are in the process of preparing for the same as the numbers are growing.
  Itamar

• Dear Itamar,
  For the last weeks we have treated and control many patients at the hospital at home unit. This strategy has allowed us to avoid the hospital colapse. Up to now, almost 300 patients have been early discharged, or have avoided the admission to the hospital from ED or nursing homes.
  I hope the situation in your hospital is not so critical like here in Madrid. Last few days, we are starting to observe a little improvement in the number of patients getting to the ED.
  Best regards
  Manuel

• That’s very crucial information for all over the world. Could you please share more about how the team work to care the patients? For example, the combination of telemedicine and home visits and the precaution equipment for healthcare providers. Thank you very much!

  Zhang from Taiwan

• Dear Kai-Ping Zhang
  We have developed a double strategy. On the one hand, some patients are followed-up by telephone by a team of doctors and nurses. On the other hand, we visit patient at home by our usual hospital-at-home team. For the telephone team, we apply a symptoms checklist in a daily basis. If we detect a worsening in a patient from the telephone group, the hospital at home team visit the patient.
  Folowing this strategy, almost 300 patient have been early discharged or have avoided admission from ED
  Regarding the equipment, we use a individual protection equipment for each visited patient, both nurses and doctors. Up to now, we have enough equipments for visiting patients.
  Thank you
  Manuel – Spain

• Dear Manuel
  Thanks for your useful information.
  This is Yu Sang-Ju, president of Taiwan Society of Home Health Care. COVID-19 has been pandemic since this March and had an overwhelming impact on the healthcare system worldwide. Home health care agencies are no exception in this fight.
  Despite that Taiwan has contained the contagion with great efforts both from the government and the people, we should still be prepared for community transmission.
  We are not optimistic to this.
  Because, every country, every city, and every community is under the risk of COVID-19 outbreaks.
  I think it is important for COVID-19@HOME WORLD COLLABORATION
  https://docs.google.com/document/d/1rfd31IKfj6-oM-P9HevYX98GuJ3CMrM4S8Ahn6HmpPI/edit

  Yu from Taiwan

• Excellent information Manuel, with a very important criterias to orient Brazil, where the pandemic is coming strong 3 weeks after Spain. It will be very useful for us. Many thanks!
  Mariana

• Thank you Mariana, I hope the crisis in Brazil is a bit better tan in Spain

• HI Manuel – thanks for sharing .
  What sort of monitoring are you undertaking for those in HITH?
  Do you utilise any form of continuous monitoring of vital signs ?
  Currently with our HITH patients we manually monitor vital signs but mostly only once per day when we go into give antibiotics and review or maximum of twice per day.
  Thanks
  Annie Balcomb
  Orange HITH
  Australia

• Hi Annie,
  We use a checklist of symptoms using telephone communication, and we lend to each patient a pulse oximeter for registering satO2 in a daily basis. We don’t have available videoconference nor telemedicine tools.
  Other patients are visited in a daily basis, according to the needs.
  Manuel

• I understand that patients are isolated with their caregiver, isn’t it? Do you make the PCR to the caregiver too before admition?
  Thank you for your information
  Elisa Rodado
  Hospital at home service of Tortosa Hospital Verge de la Cinta.

• Dear Elisa,
  We only make control PCR for patients, and not always. For caregivers and relatives PCR is made by Public Health.
  Regards
  Manuel

• Hello Dr Miron

  I find this information very very useful,
  Im working as a speciality Doctor in Acute care at home team in Lurgan hospital
  Northern irland. We will be start taking patients under our team soon and this piece
  of information can be very useful. really appreciate.
  execellent good work

  Thanks
  Bushra Khan

• Dear Bushra Khan,
  By own experience, I really think that hospital at home must play a main role in this crisis. To avoid collapse, hospitals need discharge patients in a early way and avoid admissions. But many times, patients are frail, are suffering for respiratory failure, feel unsure, if not scared to return home, and have to be monitoring in order to check a complete recovering. Some patients have fever after discharge, some have dysnea for days or even weeks, some need to be monitored for comorbidities, some are coinfected and need specific treatment…. For all these patients, hospital at home can cover most of their needs.
  For the Emergency Department, we have defined criteria to avoid admission. These are patient <60 years, with lung envolvement, without risk factors (uncontrolled hypertension/diabetes, obesity, inmunosupression, severe lung diseases, heart diseases), and some laboratory criteria.
  Most patients feel more confortable and sure when hospital is monitoring the disease at home, and I don't have any doubt that many readmissions are avoided.
  Manuel – Hospital at Home Unit. Torrejón Hospital. Madrid. Spain

• In my country, calls and video chats are still used to screen patients with coronovirus. Of course, if the patient needs additional help and examinations, we come to the house, but this is quite rare. Thank you for sharing such important information about telemedicine with colleagues.

  Thank you,

  https://andersenlab.com/services/quality-assurance-services

3. I think in my country India, it is very difficult for a doctor to visit each patient at home.However we are using technology like video calling for monitoring patients in home quarantine.

• Dear Sarang Patil,
  Yours is an ideal solutions. We combine telephone calls with visits at home when the patient have other needs. And, of course, we use individual protection equipment for each visit.
  Regards
  Manuel

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