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An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department

To evaluate the effectiveness of an integrated emergency department (ED)/hospital at home (HH) medical care model in mild COVID-19 pneumonia and evaluate baseline predictors of major outcomes and potential savings. Retrospective cohort study with patients evaluated for COVID-19 pneumonia in the ED,...

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Autores principales: Llorens, Pere, Moreno-Pérez, Oscar, Espinosa, Begoña, García, Tamara, Payá, Ana Belén, Sola, Sonia, Molina, Francisca, Román, Francisco, Jiménez, Inmaculada, Guzman, Sergio, Gil-Rodrigo, Adriana, Peña-Pardo, Bárbara, Merino, Esperanza, Gil, Joan, San-Inocencio, David, Andrés, Mariano, Sánchez-Payá, José
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903217/
https://www.ncbi.nlm.nih.gov/pubmed/33625661
http://dx.doi.org/10.1007/s11739-021-02661-8
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author Llorens, Pere
Moreno-Pérez, Oscar
Espinosa, Begoña
García, Tamara
Payá, Ana Belén
Sola, Sonia
Molina, Francisca
Román, Francisco
Jiménez, Inmaculada
Guzman, Sergio
Gil-Rodrigo, Adriana
Peña-Pardo, Bárbara
Merino, Esperanza
Gil, Joan
San-Inocencio, David
Andrés, Mariano
Sánchez-Payá, José
author_facet Llorens, Pere
Moreno-Pérez, Oscar
Espinosa, Begoña
García, Tamara
Payá, Ana Belén
Sola, Sonia
Molina, Francisca
Román, Francisco
Jiménez, Inmaculada
Guzman, Sergio
Gil-Rodrigo, Adriana
Peña-Pardo, Bárbara
Merino, Esperanza
Gil, Joan
San-Inocencio, David
Andrés, Mariano
Sánchez-Payá, José
author_sort Llorens, Pere
collection PubMed
description To evaluate the effectiveness of an integrated emergency department (ED)/hospital at home (HH) medical care model in mild COVID-19 pneumonia and evaluate baseline predictors of major outcomes and potential savings. Retrospective cohort study with patients evaluated for COVID-19 pneumonia in the ED, from March 3 to April 30, 2020. All of them were discharged home and controlled by HH. The main outcomes were ED revisit and the need for deferred hospital admission (protocol failure). Outcome predictors were analyzed by simple logistic regression model (OR; 95% CI). Potential savings of this medical care model were estimated. Of the 377 patients attended in the ED, 109 were identified as having mild pneumonia and were included in the ED/HH medical care model. Median age was 50.0 years, 52.3% were males and 57.8% had Charlson index ≥ 1. The median HH stay was 8 (IQR 3.7–11) days. COVID-19-related ED revisit was 19.2% (n = 21) within 6 days (IQR 3–12.5) after discharge from ED. Overall protocol failure (deferred hospital admission) was 6.4% (n = 7), without ICU admission. The ED/HH model provided potential cost savings of 77% compared to traditional stay, due to the costs of home care entails 23% of the expenses generated by a conventional hospital stay. 789 days of hospital stay were avoided by HH, rather than hospital admission. An innovative ED/HH model for selected patients with mild COVID-19 pneumonia is feasible, safe and effective. Less than 6.5% of patients requiring deferred hospital admission and potential savings were generated due to hospitalization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02661-8.
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spelling pubmed-79032172021-02-24 An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department Llorens, Pere Moreno-Pérez, Oscar Espinosa, Begoña García, Tamara Payá, Ana Belén Sola, Sonia Molina, Francisca Román, Francisco Jiménez, Inmaculada Guzman, Sergio Gil-Rodrigo, Adriana Peña-Pardo, Bárbara Merino, Esperanza Gil, Joan San-Inocencio, David Andrés, Mariano Sánchez-Payá, José Intern Emerg Med EM - Original To evaluate the effectiveness of an integrated emergency department (ED)/hospital at home (HH) medical care model in mild COVID-19 pneumonia and evaluate baseline predictors of major outcomes and potential savings. Retrospective cohort study with patients evaluated for COVID-19 pneumonia in the ED, from March 3 to April 30, 2020. All of them were discharged home and controlled by HH. The main outcomes were ED revisit and the need for deferred hospital admission (protocol failure). Outcome predictors were analyzed by simple logistic regression model (OR; 95% CI). Potential savings of this medical care model were estimated. Of the 377 patients attended in the ED, 109 were identified as having mild pneumonia and were included in the ED/HH medical care model. Median age was 50.0 years, 52.3% were males and 57.8% had Charlson index ≥ 1. The median HH stay was 8 (IQR 3.7–11) days. COVID-19-related ED revisit was 19.2% (n = 21) within 6 days (IQR 3–12.5) after discharge from ED. Overall protocol failure (deferred hospital admission) was 6.4% (n = 7), without ICU admission. The ED/HH model provided potential cost savings of 77% compared to traditional stay, due to the costs of home care entails 23% of the expenses generated by a conventional hospital stay. 789 days of hospital stay were avoided by HH, rather than hospital admission. An innovative ED/HH model for selected patients with mild COVID-19 pneumonia is feasible, safe and effective. Less than 6.5% of patients requiring deferred hospital admission and potential savings were generated due to hospitalization. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11739-021-02661-8. Springer International Publishing 2021-02-24 2021 /pmc/articles/PMC7903217/ /pubmed/33625661 http://dx.doi.org/10.1007/s11739-021-02661-8 Text en © Società Italiana di Medicina Interna (SIMI) 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle EM - Original
Llorens, Pere
Moreno-Pérez, Oscar
Espinosa, Begoña
García, Tamara
Payá, Ana Belén
Sola, Sonia
Molina, Francisca
Román, Francisco
Jiménez, Inmaculada
Guzman, Sergio
Gil-Rodrigo, Adriana
Peña-Pardo, Bárbara
Merino, Esperanza
Gil, Joan
San-Inocencio, David
Andrés, Mariano
Sánchez-Payá, José
An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department
title An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department
title_full An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department
title_fullStr An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department
title_full_unstemmed An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department
title_short An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department
title_sort integrated emergency department/hospital at home model in mild covid-19 pneumonia: feasibility and outcomes after discharge from the emergency department
topic EM - Original
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903217/
https://www.ncbi.nlm.nih.gov/pubmed/33625661
http://dx.doi.org/10.1007/s11739-021-02661-8
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