{"id":432,"date":"2020-09-08T22:58:21","date_gmt":"2020-09-08T22:58:21","guid":{"rendered":"https:\/\/www.hospitalinnovate.org\/covid19\/?p=432"},"modified":"2021-07-11T15:45:34","modified_gmt":"2021-07-11T15:45:34","slug":"06what-policies-are-in-place-to-determine-when-and-how-to-follow-up-with-patients-after-discharge","status":"publish","type":"post","link":"https:\/\/www.hospitalinnovate.org\/covid19\/2020\/09\/08\/06what-policies-are-in-place-to-determine-when-and-how-to-follow-up-with-patients-after-discharge\/","title":{"rendered":"06. What policies are in place to determine when and how to follow up with patients after discharge?"},"content":{"rendered":"

[vc_row full_width=”stretch_row_content_no_spaces” equal_height=”yes” content_placement=”bottom” css=”.vc_custom_1600728731439{margin-top: 0px !important;border-bottom-width: 4px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 0px !important;padding-left: 20px !important;background-color: #f2f2f2 !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;}”][vc_column width=”2\/3″ css=”.vc_custom_1599247143020{padding-right: 20px !important;padding-left: 10px !important;}”][vc_custom_heading text=”Discharge Criteria Key Clinical Questions” font_container=”tag:h2|text_align:left|color:%23f7941d” use_theme_fonts=”yes” css=”.vc_custom_1599600251861{margin-top: 0px !important;padding-top: 40px !important;}”][\/vc_column][vc_column width=”1\/3″][vc_column_text]<\/p>\n

Home<\/a> \/ Discharge Criteria Overview<\/a> \/ Key Clinical Questions<\/a><\/p>\n

[\/vc_column_text][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces” gap=”20″][vc_column width=”3\/4″ css=”.vc_custom_1599596059091{padding: 20px !important;}”][vc_custom_heading source=”post_title” use_theme_fonts=”yes”][vc_column_text]<\/p>\n

a. HOMERuN institutions<\/strong><\/h3>\n

General approaches to home monitoring after discharge included the following: 1) monitoring of temperature and\/or pulse oximetry; 2) use of patient portals or \u201ctext to chat\u201d for self-report of vital signs and symptoms; 3) phone calls from clinical personnel (e.g., registered nurse, nurse practitioner, physician assistant) to patients to elicit symptoms and\/or in the event of worsening signs and symptoms (some sites also routinely asked about medication management and elicited concerns and questions from patients); 4) triage to urgent virtual visits (hospitalist, pharmacist, palliative care) when needed; and 5) routine post-discharge follow-up (often virtual visits). Eight of the surveyed reported having at least some components of these monitoring programs; four of these use phone calls or text-to-chat only to elicit data, while the other four used questionnaires via patient portals plus phone outreach. Three sites provided home pulse oximeters and two provided home thermometers for at least some patients when needed. One site had a dedicated COVID-19 post-discharge follow-up clinic.[\/vc_column_text][vc_row_inner gap=”30″ css=”.vc_custom_1599600134655{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;}”][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n

b. What is Known<\/strong><\/h3>\n

Home monitoring programs have been studied in patients with other diseases, with modest effects (e.g., congestive heart failure). Experience with these programs have shown limited benefits. But there may be reason for benefits in patients with COVID-19. We are accumulating experience with these programs, including Northwestern<\/a>, Cleveland Clinic<\/a>, and Mount Sinai<\/a>.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_column_text]<\/p>\n

c. What is Not Known<\/strong><\/h3>\n

To date, there are limited data on the effects of these programs on patient outcomes.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner gap=”30″ css=”.vc_custom_1599600134655{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;}”][vc_column_inner][vc_column_text]<\/p>\n

d. Spring 2021 Update<\/strong><\/h3>\n
    \n
  • Many sites have recently set up Post-COVID-19 clinics. The nature of these clinics varies tremendously across sites. Some have focused on patients with chronic symptoms (\u201clong-haulers\u201d), while others focus on patients with more acute and severe symptoms<\/li>\n
  • Many sites, but not all, have more recently set up home monitoring programs to track patients after discharge. Technology at home varies, including thermometer, pulse oximeter, and\/or portable ultrasound. Many sites are using telemedicine to follow patients after discharge, and some sites have used contracted home health nurses to follow patients after discharge. These programs do not always lead to earlier discharge, but they have allowed providers to feel much more comfortable discharging patients from the hospital. A full report detailing the results of a HOMERuN-wide survey of home monitoring programs is coming soon.<\/li>\n<\/ul>\n

    [\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_column][vc_column width=”1\/4″ css=”.vc_custom_1600127317151{border-top-width: 1px !important;border-right-width: 1px !important;border-bottom-width: 1px !important;border-left-width: 4px !important;padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;border-left-color: #2c5d73 !important;border-left-style: solid !important;border-right-color: #2c5d73 !important;border-right-style: solid !important;border-top-color: #2c5d73 !important;border-top-style: solid !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;border-radius: 4px !important;}”][vc_raw_html]JTVCdWx0aW1hdGVfcG9zdF9saXN0JTIwaWQlM0QlMjI0MTMlMjIlNUQ=[\/vc_raw_html][vc_wp_custommenu nav_menu=”6″ title=”Discharge Criteria” el_class=”subNavButton”][\/vc_column][\/vc_row][vc_row full_width=”stretch_row_content_no_spaces”][vc_column][cesis_line_divider width=””][vc_column_text font_size=”10px” css=”.vc_custom_1599599758239{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;background-color: #f9f9f9 !important;}”][\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"

    Nineteen percent of protocols recommended standard pharmacologic VTE prophylaxis dosing for all COVID-19 patients regardless of estimated VTE risk. Ten percent recommended…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[],"_links":{"self":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/432"}],"collection":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/comments?post=432"}],"version-history":[{"count":5,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/432\/revisions"}],"predecessor-version":[{"id":1314,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/posts\/432\/revisions\/1314"}],"wp:attachment":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/media?parent=432"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/categories?post=432"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/tags?post=432"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}