An integrated emergency department/hospital at home model in mild COVID-19 pneumonia : feasibility and outcomes after discharge from the emergency department
© 2021. Società Italiana di Medicina Interna (SIMI)..
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.
| Errataetall: |
CommentIn: Intern Emerg Med. 2021 Sep;16(6):1645-1646. - PMID 33864543 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:16 |
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| Enthalten in: |
Internal and emergency medicine - 16(2021), 6 vom: 24. Sept., Seite 1673-1682 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Llorens, Pere [VerfasserIn] |
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| Links: |
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| Themen: |
COVID-19 |
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| Anmerkungen: |
Date Completed 24.08.2021 Date Revised 24.08.2021 published: Print-Electronic CommentIn: Intern Emerg Med. 2021 Sep;16(6):1645-1646. - PMID 33864543 Citation Status MEDLINE |
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| doi: |
10.1007/s11739-021-02661-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM321839641 |
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| 500 | |a CommentIn: Intern Emerg Med. 2021 Sep;16(6):1645-1646. - PMID 33864543 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. Società Italiana di Medicina Interna (SIMI). | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Emergency department | |
| 650 | 4 | |a Hospital based home cares | |
| 650 | 4 | |a Pneumonia | |
| 700 | 1 | |a Moreno-Pérez, Oscar |e verfasserin |4 aut | |
| 700 | 1 | |a Espinosa, Begoña |e verfasserin |4 aut | |
| 700 | 1 | |a García, Tamara |e verfasserin |4 aut | |
| 700 | 1 | |a Payá, Ana Belén |e verfasserin |4 aut | |
| 700 | 1 | |a Sola, Sonia |e verfasserin |4 aut | |
| 700 | 1 | |a Molina, Francisca |e verfasserin |4 aut | |
| 700 | 1 | |a Román, Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Jiménez, Inmaculada |e verfasserin |4 aut | |
| 700 | 1 | |a Guzman, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Gil-Rodrigo, Adriana |e verfasserin |4 aut | |
| 700 | 1 | |a Peña-Pardo, Bárbara |e verfasserin |4 aut | |
| 700 | 1 | |a Merino, Esperanza |e verfasserin |4 aut | |
| 700 | 1 | |a Gil, Joan |e verfasserin |4 aut | |
| 700 | 1 | |a San-Inocencio, David |e verfasserin |4 aut | |
| 700 | 1 | |a Andrés, Mariano |e verfasserin |4 aut | |
| 700 | 1 | |a Sánchez-Payá, José |e verfasserin |4 aut | |
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