Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up

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Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Metho...

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Autores principales: Pedretti, Ana, Marquez Fosser, Santiago, Pasquinelli, Rosario, Vallone, Marcelo, Plazzotta, Fernando, Luna, Daniel, Martinez, Bernardo, Rodriguez, Paz, Grande Ratti, María Florencia
Formato: Artículo revista
Lenguaje:Inglés
Publicado: Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021
Materias:
emergency medical services
coronavirus infections
ambulatory care
telemedicine
patient readmission
servicios médicos de urgencia
infecciones por coronavirus
atención ambulatoria
telemedicina
readmisión del paciente
serviços médicos de emergência
infecções por coronavirus
assistência ambulatorial
readmissão do paciente
Acceso en línea:https://revistas.unc.edu.ar/index.php/med/article/view/32414
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Revista de la Facultad de Ciencias Médicas de Córdoba de Universidad Nacional de Córdoba
id I10-R327-article-32414
record_format ojs
institution Universidad Nacional de Córdoba
institution_str I-10
repository_str R-327
container_title_str Revista de la Facultad de Ciencias Médicas de Córdoba
language Inglés
format Artículo revista
topic emergency medical services
coronavirus infections
ambulatory care
telemedicine
patient readmission
servicios médicos de urgencia
infecciones por coronavirus
atención ambulatoria
telemedicina
readmisión del paciente
serviços médicos de emergência
infecções por coronavirus
assistência ambulatorial
telemedicina
readmissão do paciente
spellingShingle emergency medical services
coronavirus infections
ambulatory care
telemedicine
patient readmission
servicios médicos de urgencia
infecciones por coronavirus
atención ambulatoria
telemedicina
readmisión del paciente
serviços médicos de emergência
infecções por coronavirus
assistência ambulatorial
telemedicina
readmissão do paciente
Pedretti, Ana
Marquez Fosser, Santiago
Pasquinelli, Rosario
Vallone, Marcelo
Plazzotta, Fernando
Luna, Daniel
Martinez, Bernardo
Rodriguez, Paz
Grande Ratti, María Florencia
Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up
topic_facet emergency medical services
coronavirus infections
ambulatory care
telemedicine
patient readmission
servicios médicos de urgencia
infecciones por coronavirus
atención ambulatoria
telemedicina
readmisión del paciente
serviços médicos de emergência
infecções por coronavirus
assistência ambulatorial
telemedicina
readmissão do paciente
author Pedretti, Ana
Marquez Fosser, Santiago
Pasquinelli, Rosario
Vallone, Marcelo
Plazzotta, Fernando
Luna, Daniel
Martinez, Bernardo
Rodriguez, Paz
Grande Ratti, María Florencia
author_facet Pedretti, Ana
Marquez Fosser, Santiago
Pasquinelli, Rosario
Vallone, Marcelo
Plazzotta, Fernando
Luna, Daniel
Martinez, Bernardo
Rodriguez, Paz
Grande Ratti, María Florencia
author_sort Pedretti, Ana
title Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up
title_short Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up
title_full Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up
title_fullStr Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up
title_full_unstemmed Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up
title_sort risk of readmission to the emergency department in mild covid-19 outpatients with telehealth follow-up
description Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.
publisher Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
publishDate 2021
url https://revistas.unc.edu.ar/index.php/med/article/view/32414
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first_indexed 2024-09-03T21:02:17Z
last_indexed 2024-09-03T21:02:17Z
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spelling I10-R327-article-324142021-11-18T12:43:09Z Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up Riesgo de reconsulta al servicio de urgencias en pacientes COVID-19 leves con seguimiento ambulatorio mediante telemedicina Risco de readmissão ao departamento de emergência em pacientes ambulatoriais com COVID-19 leve com acompanhamento de telessaúde Pedretti, Ana Marquez Fosser, Santiago Pasquinelli, Rosario Vallone, Marcelo Plazzotta, Fernando Luna, Daniel Martinez, Bernardo Rodriguez, Paz Grande Ratti, María Florencia emergency medical services coronavirus infections ambulatory care telemedicine patient readmission servicios médicos de urgencia infecciones por coronavirus atención ambulatoria telemedicina readmisión del paciente serviços médicos de emergência infecções por coronavirus assistência ambulatorial telemedicina readmissão do paciente Introduction: To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods: We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results: We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion: The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety. Introducción: Describir las características de los pacientes COVID-19 con síntomas leves dados de alta desde la Central de Emergencias de Adultos (CEA) y seguidos en forma ambulatoria mediante telemedicina. Estimar las tasas de re-consulta a CEA y hospitalización, y explorar los factores asociados a estos desenlaces. Métodos: Cohorte retrospectiva de Junio a Agosto 2020 en el Hospital Italiano de Buenos Aires, que incluyó personas COVID-19 con síntomas leves. Se siguieron durante 14 días hasta la ocurrencia de re-consulta en CEA y/o hospitalización. Se utilizaron modelos de Kaplan-Meier y regresión logística. Resultados: De un total de 1.239 pacientes, con una mediana de 41 años y 53,82% varones, 167 pacientes re-consultaron a CEA, con una tasa de incidencia global a los 14 días del 13,08% (IC del 95% 11,32 a 15,08). De estos, 83 requirieron hospitalización (media de 4,98 días), el 6% no se relaciona con COVID-19 y 5 pacientes fallecieron. Después del ajuste por factores confundidores (edad ≥65, sexo, diabetes, hipertensión, ex tabaquismo, tabaquismo activo, fiebre, diarrea y saturación de oxígeno), encontramos asociaciones significativas: tabaquismo anterior (ORa 2,09, IC95% 1,31-3,34, p0=0,002), fiebre (ORa 1,56, IC95% 1,07-2,28, p=0,002) y saturación de oxígeno (ORa 0,82, IC95% 0,71-0,95, p=0,009). Conclusión: La tasa del 13% de re-consulta a CEA durante 14 días de seguimiento resultó muy significativa para la gestión hospitalaria, la calidad del desempeño y la seguridad del paciente. Introdução: Descrever as características dos pacientes com COVID-19 com sintomas leves e alta do Centro de Emergência de Adultos (CEA) e acompanhados ambulatorialmente por telemedicina. Estime as taxas de nova consulta ao CEA e de hospitalização e explore os fatores associados a esses resultados. Métodos: Coorte retrospectiva de junho a agosto de 2020 no Hospital Italiano de Buenos Aires, que incluiu COVID-19 com sintomas leves. Eles foram acompanhados por 14 dias até a ocorrência de nova consulta no CEA e / ou internação. Modelos de Kaplan-Meier e regressão logística foram usados. Resultados: De um total de 1.239 pacientes, com mediana de 41 anos e 53,82% homens, 167 pacientes consultaram novamente o CEA, com uma taxa de incidência global em 14 dias de 13,08% (IC95% 11,32 a 15,08). Destes, 83 necessitaram de hospitalização (média de 4,98 dias), 6% não estavam relacionados com COVID-19 e 5 pacientes morreram. Após o ajuste para fatores de confusão (idade ≥65, sexo, diabetes, hipertensão, ex-tabagismo, tabagismo ativo, febre, diarreia e saturação de oxigênio), encontramos associações significativas: tabagismo prévio (ORa 2,09, IC 95% 1,31-3,34, p0 = 0,002), febre (ORa 1,56, IC 95% 1,07-2,28, p = 0,002) e saturação de oxigênio (ORa 0,82, IC 95% 0,71-0,95, p = 0,009). Conclusão: A taxa de 13% de re-consulta ao CEA durante 14 dias de seguimento foi muito significativa para a gestão hospitalar, qualidade do desempenho e segurança do paciente. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-08-23 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf text/html https://revistas.unc.edu.ar/index.php/med/article/view/32414 10.31053/1853.0605.v78.n3.32414 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. 3 (2021); 249-256 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. 3 (2021); 249-256 Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. 3 (2021); 249-256 1853-0605 0014-6722 10.31053/1853.0605.v78.n3 eng https://revistas.unc.edu.ar/index.php/med/article/view/32414/34869 https://revistas.unc.edu.ar/index.php/med/article/view/32414/34870 Derechos de autor 2021 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0

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