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Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital

INTRODUCTION: In May 2020 a virtual ward for COVID-19 patients seen at University College London Hospital (UCLH) was established. The aim of this study was to see if specific factors can be used to predict the risk of deterioration and need for Emergency Department (ED) reattendance or admission. ME...

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Autores principales: Crilly, Declan, Shakeshaft, Peter, Marks, Michael, Logan, Sarah, Cutfield, Tim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10337886/
https://www.ncbi.nlm.nih.gov/pubmed/37437035
http://dx.doi.org/10.1371/journal.pone.0284997
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author Crilly, Declan
Shakeshaft, Peter
Marks, Michael
Logan, Sarah
Cutfield, Tim
author_facet Crilly, Declan
Shakeshaft, Peter
Marks, Michael
Logan, Sarah
Cutfield, Tim
author_sort Crilly, Declan
collection PubMed
description INTRODUCTION: In May 2020 a virtual ward for COVID-19 patients seen at University College London Hospital (UCLH) was established. The aim of this study was to see if specific factors can be used to predict the risk of deterioration and need for Emergency Department (ED) reattendance or admission. METHODS: We performed a service evaluation of the COVID-19 virtual ward service at UCLH between 24/10/2020 and 12/2/2021. 649 patients were included with data collected on vital signs, basic measurements, and blood tests from their initial ED attendance, allowing calculation of ISARIC-4C mortality scores. Outcomes of interest were ED reattendance, facilitation of this by virtual ward physician, level of care if admitted, and death within 28 days of the first COVID-19 virtual ward appointment. Analysis was performed using Mann-Whitney U tests. RESULTS: Reattendance rate to ED was 17.3% (112/649) of which 8% (51/649) were admitted. Half of ED reattendances were facilitated by the virtual ward service. Overall mortality was 0.92%. Patients who reattended ED, facilitated by the virtual ward service, had a higher mean CRP (53.63 vs 41.67 mg/L), presented to ED initially later in their COVID-19 illness (8 vs 6.5 days) and had a higher admission rate (61 vs 39%). The mean ISARIC-4C score was higher in the reattendance group compared to the non-reattendance group (3.87 vs 3.48, difference of 0.179, p = 0.003). The mean ISARIC-4C score was higher in the admission group than the non-reattendance group (5.56 vs 3.48, difference of 0.115, p = 0.003). CONCLUSION: Identification of patient risk factors for reattendance following a diagnosis of COVID-19 in ED can be used to design a service to safely manage patients remotely. We found that the ISARIC -4C mortality score was associated with risk of hospital admission and could be used to identify those requiring more active remote follow up.
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spelling pubmed-103378862023-07-13 Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital Crilly, Declan Shakeshaft, Peter Marks, Michael Logan, Sarah Cutfield, Tim PLoS One Research Article INTRODUCTION: In May 2020 a virtual ward for COVID-19 patients seen at University College London Hospital (UCLH) was established. The aim of this study was to see if specific factors can be used to predict the risk of deterioration and need for Emergency Department (ED) reattendance or admission. METHODS: We performed a service evaluation of the COVID-19 virtual ward service at UCLH between 24/10/2020 and 12/2/2021. 649 patients were included with data collected on vital signs, basic measurements, and blood tests from their initial ED attendance, allowing calculation of ISARIC-4C mortality scores. Outcomes of interest were ED reattendance, facilitation of this by virtual ward physician, level of care if admitted, and death within 28 days of the first COVID-19 virtual ward appointment. Analysis was performed using Mann-Whitney U tests. RESULTS: Reattendance rate to ED was 17.3% (112/649) of which 8% (51/649) were admitted. Half of ED reattendances were facilitated by the virtual ward service. Overall mortality was 0.92%. Patients who reattended ED, facilitated by the virtual ward service, had a higher mean CRP (53.63 vs 41.67 mg/L), presented to ED initially later in their COVID-19 illness (8 vs 6.5 days) and had a higher admission rate (61 vs 39%). The mean ISARIC-4C score was higher in the reattendance group compared to the non-reattendance group (3.87 vs 3.48, difference of 0.179, p = 0.003). The mean ISARIC-4C score was higher in the admission group than the non-reattendance group (5.56 vs 3.48, difference of 0.115, p = 0.003). CONCLUSION: Identification of patient risk factors for reattendance following a diagnosis of COVID-19 in ED can be used to design a service to safely manage patients remotely. We found that the ISARIC -4C mortality score was associated with risk of hospital admission and could be used to identify those requiring more active remote follow up. Public Library of Science 2023-07-12 /pmc/articles/PMC10337886/ /pubmed/37437035 http://dx.doi.org/10.1371/journal.pone.0284997 Text en © 2023 Crilly et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Crilly, Declan
Shakeshaft, Peter
Marks, Michael
Logan, Sarah
Cutfield, Tim
Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital
title Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital
title_full Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital
title_fullStr Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital
title_full_unstemmed Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital
title_short Evaluation of a remote monitoring service for patients with COVID-19 discharged from University College London Hospital
title_sort evaluation of a remote monitoring service for patients with covid-19 discharged from university college london hospital
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10337886/
https://www.ncbi.nlm.nih.gov/pubmed/37437035
http://dx.doi.org/10.1371/journal.pone.0284997
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