Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review

Cecilia Vindrola-Padros; Kelly E Singh; Manbinder S Sidhu; Theo Georghiou; Chris Sherlaw-Johnson; Sonila M Tomini; Matthew Inada-Kim; Karen Kirkham; Allison Streetly; Nathan Cohen; Naomi J Fulop

doi:10.1016/j.eclinm.2021.100965

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review

EClinicalMedicine. 2021 Jul:37:100965. doi: 10.1016/j.eclinm.2021.100965. Epub 2021 Jun 23.

Authors

Affiliations

¹ Department of Targeted Intervention, University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TY, United Kingdom.
² Health Services Management Centre, School of Social Policy, University of Birmingham, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK.
³ Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK.
⁴ Department of Applied Health Research, University College London, Gower Street London, WC1E 6BT, UK.
⁵ Wessex Academic Health and Science Network, National COVID Clinical Reference groups- Primary care, Secondary care, Care homes, National Clinical Lead Deterioration and National Specialist Advisor Sepsis, NHS England and NHS Improvement, McGill ward, Royal Hampshire County Hospital, Romsey Road, Winchester SO21 1QW, UK.
⁶ Integrated Care System Clinical Lead, NHSE/I Senior Medical Advisor Primary Care Transformation, Dorset CCG, Vespasian House, Barrack Rd, Dorchester DT1 7TG, UK.
⁷ Department of Population Health Sciences Faculty of Life Sciences and Medicine King's College London SE1 1UL, UK.
⁸ Deputy National Lead Healthcare Public Health, Public Health England133-155 Waterloo Rd, London SE1 8UG, UK.
⁹ University College London, UK.

Abstract

Background: the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt.

Methods: we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. The search was updated on February 2021. We used the PRISMA statement and the review was registered on PROSPERO (CRD: 42020202888).

Findings: the review included 27 articles. The aim of the models was to maintain patients safe in the appropriate setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/career training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored.

Interpretation: future research should focus on staff and patient experiences of care and inequalities in patients' access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools.

Keywords: COVID-19; Rapid systematic review; Remote home monitoring; SARS-CoV-2; Silent hypoxia; Virtual wards.