Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Medicine, Alexandra Hospital, 378 Alexandra Road, Singapore, 159964, Singapore.
BMC Infect Dis. 2023 Feb 21;23(1):102. doi: 10.1186/s12879-023-08040-2.
To address the hospital bed demand for Delta and Omicron surges in Singapore, the National University Health System (NUHS) developed a COVID Virtual Ward to relieve bed pressures on its three acute hospitals-National University Hospital, Ng Teng Fong General Hospital, Alexandra Hospital. To serve a multilingual population, the COVID Virtual Ward featuring protocolized teleconsultation of high-risk patients, use of a vital signs chatbot, supplemented by home visits where necessary. This study aims to evaluate the safety, outcomes and utilisation of the Virtual Ward as a scalable response to COVID-19 surges.
This is a retrospective cohort study of all patients admitted to the COVID Virtual Ward between 23 September to 9 November 2021. Patients were defined as "early discharge" if they were referred from inpatient COVID-19 wards and "admission avoidance" if they were referred directly from primary care or emergency services. Patient demographics, utilisation measures and clinical outcomes were extracted from the electronic health record system. The primary outcomes were escalation to hospital and mortality. Use of the vital signs chatbot was evaluated by examining compliance levels, need for automated reminders and alerts triggered. Patient experience was evaluated using data extracted from a quality improvement feedback form.
238 patients were admitted to the COVID Virtual Ward from 23 September to 9 November, of whom 42% were male, 67.6% of Chinese ethnicity. 43.7% were over the age of 70, 20.5% were immunocompromised, and 36.6% were not fully vaccinated. 17.2% of patients were escalated to hospital and 2.1% of patients died. Patients who were escalated to hospital were more likely to be immunocompromised or to have a higher ISARIC 4C-Mortality Score. There were no missed deteriorations. All patients received teleconsults (median of 5 teleconsults per patient, IQR 3-7). 21.4% of patients received home visits. 77.7% of patients engaged with the vital signs chatbot, with a compliance rate of 84%. All patients would recommend the programme to others in their situation.
Virtual Wards are a scalable, safe and patient-centered strategy to care for high risk COVID-19 patients at home.
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为应对新加坡德尔塔和奥密克戎疫情导致的医院床位需求，新加坡国立大学卫生系统（NUHS）开发了一个 COVID 虚拟病房，以减轻其三家急症医院-国立大学医院、黄廷芳综合医院、亚历山大医院的床位压力。为了服务多语言人群，COVID 虚拟病房采用了对高危患者进行协议化远程咨询、使用生命体征聊天机器人的方式，并在必要时补充家庭访问。本研究旨在评估虚拟病房作为应对 COVID-19 疫情的可扩展应对措施的安全性、结果和利用情况。
这是一项对 2021 年 9 月 23 日至 11 月 9 日期间入住 COVID 虚拟病房的所有患者的回顾性队列研究。如果患者从住院 COVID-19 病房转来，则定义为“提前出院”；如果患者直接从初级保健或急诊服务转来，则定义为“避免住院”。从电子健康记录系统中提取患者的人口统计学、利用措施和临床结果数据。主要结局是升级到医院和死亡。通过检查合规水平、自动提醒和触发的警报来评估生命体征聊天机器人的使用情况。通过从质量改进反馈表中提取的数据评估患者体验。
2021 年 9 月 23 日至 11 月 9 日期间，共有 238 名患者入住 COVID 虚拟病房，其中 42%为男性，67.6%为华裔。43.7%的患者年龄在 70 岁以上，20.5%的患者免疫功能低下，36.6%的患者未完全接种疫苗。17.2%的患者升级到医院，2.1%的患者死亡。升级到医院的患者更有可能免疫功能低下或 ISARIC 4C 死亡率评分更高。没有错过病情恶化的情况。所有患者都接受了远程咨询（中位数为每位患者 5 次远程咨询，IQR 3-7）。21.4%的患者接受了家访。77.7%的患者使用了生命体征聊天机器人，合规率为 84%。所有患者都会向处于他们这种情况的其他人推荐该项目。
虚拟病房是一种可扩展的、安全的、以患者为中心的策略，可以在家中照顾高危 COVID-19 患者。
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