Most patients with Covid-19 don’t require hospitalization. So how do you monitor patients who have COVID-19 symptoms but are not ill enough to come to the emergency department? And how do you help those patients feel cared about and less frightened while convalescing at home? Here’s how one health system tracked their illness, offered support, and identified cases where worsening symptoms required emergency department care or hospitalization.
Dr. Jeffrey Linder, Northwestern Medicine chief of general internal medicine and geriatrics, recently mounted a massive, new, daily home-monitoring program of patients presumed positive for COVID-19 with the assistance of nurses, nurse practitioners, a large workforce of medical students, physicians’ assistants and daily questionnaires delivered through the Electronic Health Record portal.
The results: 7,604 patients monitored, of whom about 500 were sent to the emergency department. “We were able to catch these patients before their condition dangerously deteriorated, which improved our ability to treat them,” said Linder, who also is a professor of medicine at Northwestern University Feinberg School of Medicine.
Early results from the program were published June 16 in New England Journal of Medicine Catalyst.”We started the program to address the needs of the 80% of patients who would spend their entire course of COVID-19 at home,” Linder said. “We knew from early COVID-19 experience patients could deteriorate quickly. We also suspected they may have a lot of questions about quarantine, the course of the disease and lots of social needs.”The program works by proactively reaching out to patients to ensure they are safe in their homes rather than waiting for them to identify a worsening of their condition. Patients fill out an online patient portal questionnaire and a monitoring team member calls the individual to follow up on any concerning symptoms they report, such as shortness of breath, chest pain or confusion
Team members also call any individuals who do not report symptoms via the patient portal or who simply don’t use it. On the call, health care providers assess and triage individuals for urgent medical care if they report severe symptoms like confusion, trouble breathing or bluish lips or face. They also refer patients to social work for non-medical challenges, such as difficulty with finances or accessing food.
“This model could be used for other acute conditions where quick deterioration is likely,” Linder said. “The program has been especially helpful for giving our physicians something to offer a patient when there is really no treatment available. For example, could we see changes in antibiotic prescribing habits for other respiratory infections if physicians had the option to enroll a patient in a monitoring program rather than send a patient home with nothing?”