51 Interactive Home Monitoring of ED Patients with Suspected or Confirmed COVID-19

Study Objectives: Remote in-home monitoring technology has become an increasingly important means to conserve hospital and emergency department (ED) capacity while providing observation and care for high-risk patients with milder symptoms during the COVID-19 pandemic We aimed to evaluate the safety of introducing an Interactive Home Monitoring program (IHM) for high-risk patients discharged from the emergency department (ED) with suspected or confirmed COVID-19 who without remote monitoring would have required admission to the hospital Methods: We assessed the clinical outcome of ED patients with suspected or confirmed COVID-19 who had a risk factors for severe disease and were discharged from the ED with IHM Patients were identified for enrollment in the IHM program if they had suspected or confirmed COVID-19 and had risk factors for severe illness from COVID-19 as defined by the Centers for Disease Control and Prevention (CDC) guidelines Eligible ED patients were required to be hemodynamically stable with no new oxygen requirement, but assessed by an ED attending physician as needing hospital admission Patients who met criteria were enrolled in the IHM program prior to ED discharge and were provided with equipment including a blood pressure cuff, pulse oximeter, thermometer, iPad, instructions on how to use the equipment, and 24 hour technical assistance hotline At home patients were remotely managed by trained Advanced Practitioner Providers who addressed vital sign changes and escalated care needs when appropriate The clinical course of IHM patients including return ED visits, hospital admissions, and hospital course were followed for 30 days following ED discharge Results: A total of 52 ED patients were enrolled in the IHM program from 4/15/20 to 5/30/20 7 patients required a return visit to the ED (13%;95% CI) with 6 patients requiring admission to the hospital (12%, CI 95%) All 6 admitted patients (100%) were admitted a floor bed with a mean length-of-stay of 3 3 days (s = 1 7 days) The most common reason for admission was hypoxia (50%) or dehydration (50%) No IHM patient required intubation, non-invasive positive pressure ventilation, or respiratory support beyond 2-4 liters of supplemental oxygen The one patient who presented to the ED but did not require admission was diagnosed with non-COVID related chest pain No mortalities occurred during the study period nor were there any documented adverse outcomes noted for patients discharged home on IHM Conclusion: In this initial review to assess the safety of introducing IHM for high-risk ED patients with confirmed or suspected COVID, we found that patients without a new oxygen requirement and stable vital signs could be discharged home with remote monitoring without increasing the risk for adverse clinical outcomes Additionally, the introduction of the IHM program reduced hospital admissions for this patient population, decreased potential hospital exposures, and conserved critical inpatient beds for unstable patients requiring onsite medical care