An integrated emergency department/hospital at home model in mild COVID-19 pneumonia: feasibility and outcomes after discharge from the emergency department.
Por:
Llorens P, Moreno-Pérez O, Espinosa B, García T, Payá AB, Sola S, Molina F, Román F, Jiménez I, Guzman S, Gil-Rodrigo A, Peña-Pardo B, Merino E, Gil J, San-Inocencio D, Andrés M and Sánchez-Payá J
Publicada:
1 sep 2021
Ahead of Print:
24 feb 2021
Resumen:
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.
Filiaciones:
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
Clinical Medicine Department, Miguel Hernández University, Elche, Spain
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Endocrinology and Nutrition Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, Alicante, Spain
Clinical Medicine Department, Miguel Hernández University, Elche, Spain
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
Sola S:
Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
Molina F:
Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain.
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Emergency Department, Institute of Sanitary and Biomedical Research (ISABIAL), Alicante General University Hospital, Alicante, s/n, Maestro Alonso Street, 03010, Alicante, Spain
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Unit of Infectious Diseases, Alicante General University Hospital, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
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Pneumology Department, Alicante General University Hospital, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
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Hospital-at-Home Unit, Department, Alicante General University Hospital, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
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Clinical Medicine Department, Miguel Hernández University, Elche, Spain
Rheumatology Department, Alicante General University Hospital, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
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Preventive Department, Alicante General University Hospital, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain
Green Published, Bronze
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