Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Virginia, USA.
Division of General, Geriatric, Hospital and Palliative Medicine, University of Virginia, Charlottesville, Virginia, USA.
Telemed J E Health. 2021 Jan;27(1):102-106. doi: 10.1089/tmj.2020.0236. Epub 2020 Jul 9.
The vulnerability of postacute and long-term care (PA/LTC) facility residents to COVID-19 has manifested across the world with increasing facility outbreaks associated with high hospitalization and mortality rates. Systematic protocols to guide telehealth-centered interventions in response to COVID-19 outbreaks have yet to be delineated. This article is intended to inform PA/LTC facilities and neighboring health care partners how to collaboratively utilize telehealth-centered strategies to improve outcomes in facility outbreaks. : The University of Virginia rapidly developed a multidisciplinary telehealth-centered COVID-19 facility outbreak strategy in response to a LTC facility outbreak in which 41 (out of 48) facility residents and 7 staff members tested positive. This strategy focused on supporting the facility team remotely using rapidly deployed technologic solutions. Goals included (1) early identification of patients who need their care escalated, (2) monitoring and treating patients deemed safe to remain in the facility, (3) care coordination to facilitate bidirectional transfers between the skilled nursing facility (SNF) and hospital, and (4) daily facility needs assessment related to technology, infection control, and staff well-being. To achieve these goals, a standardized approach centered on daily multidisciplinary virtual rounds and telemedicine consultation was provided. Over a month since the outbreak began, 18 out of 48 (38%) facility residents required hospitalization and 6 (12.5%) died. Eleven facility residents have since returned back to the SNF after recovering from their hospitalization. No staff required hospitalization. Interventions that reduce hospitalizations and mortality are a critical need during the COVID-19 pandemic. The mortality and hospitalization rates seen in this PA/LTC facility outbreak are significantly lower than has been documented in other facility outbreaks. Our multidisciplinary approach centered on telemedicine should be considered as other PA/LTC facilities partner with neighboring health care systems in responding to COVID-19 outbreaks. We have begun replicating these services to additional PA/LTC facilities facing COVID-19 outbreaks.
长期护理机构（PA/LTC）的居民易受 COVID-19 的影响，世界各地的长期护理机构都出现了越来越多的疫情爆发，导致住院率和死亡率居高不下。针对 COVID-19 疫情爆发，还没有系统的协议来指导以远程医疗为中心的干预措施。本文旨在为 PA/LTC 机构和邻近的医疗保健合作伙伴提供信息，说明如何共同利用以远程医疗为中心的策略来改善机构疫情爆发的结果。
弗吉尼亚大学迅速制定了一项多学科以远程医疗为中心的 COVID-19 机构疫情爆发策略，以应对一家长期护理机构爆发疫情，该机构有 41 名（48 名）居民和 7 名工作人员检测呈阳性。该策略专注于使用快速部署的技术解决方案远程为机构团队提供支持。目标包括：（1）早期识别需要加强护理的患者；（2）监测和治疗被认为安全留在机构内的患者；（3）护理协调，以促进熟练护理设施（SNF）和医院之间的双向转院；（4）每天评估与技术、感染控制和员工福祉相关的机构需求。为了实现这些目标，提供了以每日多学科虚拟查房和远程医疗咨询为中心的标准化方法。
自疫情爆发以来已经过去了一个多月，48 名居民中有 18 人（38%）需要住院治疗，6 人（12.5%）死亡。11 名居民在康复后已返回 SNF。没有工作人员需要住院治疗。
在 COVID-19 大流行期间，减少住院和死亡率的干预措施是当务之急。在这个 PA/LTC 机构爆发中看到的死亡率和住院率明显低于其他机构爆发中记录的死亡率和住院率。我们的多学科方法以远程医疗为中心，应该被视为其他 PA/LTC 机构在应对 COVID-19 疫情爆发时与邻近的医疗保健系统合作的一种选择。我们已经开始将这些服务复制到其他面临 COVID-19 疫情爆发的 PA/LTC 机构。
