Background: The SARS-CoV-2 pandemic has required healthcare systems around the world to rapidly innovate and adapt to unprecedented operational and clinical strain. Anticipated limitations in healthcare resource allocation is coupled by the strife caused by the variable clinical course of COVID-19 and the isolation of families inevitable with an inpatient admission. Many healthcare systems have leveraged virtual care capabilities as an innovative means to safely and efficiently monitor patients while reducing staff exposure and resource constraints.
Methods: Faced with this unparalleled challenge, our organization established the COVID-19 Remote Patient Monitoring (CRPM) pilot, a one-year project to equip COVID-19 patients needing additional monitoring with a home healthcare kit and 24/7 oversight from critical-care certified nurses to ensure a higher level of post-hospital care. Our goal was to ensure the safety and efficacy of the pilot in COVID-19 patients.
Results: Since December 2020, 123 patients were enrolled in the pilot. 113 (92%) of the patients enrolled have been subsequently discharged, with 9 currently active patients. A total of 224 inpatient, non-ICU bed days were saved. Inpatient bed days saved was determined based on estimates from the primary medical team at enrollment. The average number of days enrolled was 16.3 days. Regarding the safety of the pilot, 25 (21%) of patients were referred at one time to a higher level of care, with 14 (11%) requiring re-admission and 1 (0.8%) requiring an intensive care unit (ICU) level admission. The average number of days monitored prior to care escalation was 9 days. Using a variable cost for non-ICU bed day of $3,058, this project noted a cumulative variable cost savings from bed days saved of $686,521.00.
Conclusions: Remote health monitoring has been established in multiple clinical models as an effective adjunct to ensure treatment regimen adherence, make real-time treatment adjustments, and identify patients at risk for decompensation early. The COVID-19 Remote Patient Monitoring Pilot’s initial aim was to demonstrate the safety and efficacy of the remote monitoring system in COVID-19. In over two-hundred encounters across eight different MTFs, 90% of enrolled patients were eventually discharged successfully without negative outcomes. By demonstrating safety and efficacy in COVID-19, remote health monitoring has the potential in our facility to be expanded to include diagnoses such as blood pressure monitoring, congestive heart failure, chronic obstructive pulmonary disease (COPD), maternal fetal medicine, oncology, and same-day surgery recovery.