Discharge Criteria Key Clinical Questions
06. What policies are in place to determine when and how to follow up with patients after discharge?
a. HOMERuN institutions
General approaches to home monitoring after discharge included the following: 1) monitoring of temperature and/or pulse oximetry; 2) use of patient portals or “text to chat” for self-report of vital signs and symptoms; 3) phone calls from clinical personnel (e.g., registered nurse, nurse practitioner, physician assistant) to patients to elicit symptoms and/or in the event of worsening signs and symptoms (some sites also routinely asked about medication management and elicited concerns and questions from patients); 4) triage to urgent virtual visits (hospitalist, pharmacist, palliative care) when needed; and 5) routine post-discharge follow-up (often virtual visits). Eight of the surveyed reported having at least some components of these monitoring programs; four of these use phone calls or text-to-chat only to elicit data, while the other four used questionnaires via patient portals plus phone outreach. Three sites provided home pulse oximeters and two provided home thermometers for at least some patients when needed. One site had a dedicated COVID-19 post-discharge follow-up clinic.
b. What is Known
Home monitoring programs have been studied in patients with other diseases, with modest effects (e.g., congestive heart failure). Experience with these programs have shown limited benefits. But there may be reason for benefits in patients with COVID-19. We are accumulating experience with these programs, including Northwestern, Cleveland Clinic, and Mount Sinai.
c. What is Not Known
To date, there are limited data on the effects of these programs on patient outcomes.
d. Spring 2021 Update
- Many sites have recently set up Post-COVID-19 clinics. The nature of these clinics varies tremendously across sites. Some have focused on patients with chronic symptoms (“long-haulers”), while others focus on patients with more acute and severe symptoms
- Many sites, but not all, have more recently set up home monitoring programs to track patients after discharge. Technology at home varies, including thermometer, pulse oximeter, and/or portable ultrasound. Many sites are using telemedicine to follow patients after discharge, and some sites have used contracted home health nurses to follow patients after discharge. These programs do not always lead to earlier discharge, but they have allowed providers to feel much more comfortable discharging patients from the hospital. A full report detailing the results of a HOMERuN-wide survey of home monitoring programs is coming soon.