Médecine communautaire et éducation à la santé

Abstrait

Hospital at Home: A Multidisciplinary Approach to Managing Frail Older Patients in the Community with COVID-19 Infection

Ruth Porther* , Kate Thorburn, Lauren Evans, Priya Fernando

Background Hospital at home (HaH) teams are in a position to offer escalation of treatment in the communityfor frail older patients with COVID-19 infection to avoid potential adverse outcomes of hospitalisation. Torfaen Community Resource Team (CRT) is one such HaH team in South Wales. Objective To evaluate the outcomes ofpatients with COVID-19 infection managed by Torfaen CRT. Methods Prospective records were kept of all patients under the care of Torfaen CRT who received a nasopharyngeal PCR test for possible COVID-19 infection betweenMarch 2020 and March 2021. An audit was undertaken collecting data on test results, severity of COVID-19 infection, treatment given, elements of advanced care planning and outcome on discharge. Results 32 patients weremanaged under Torfaen CRT as positive for or likely COVID-19 infection. 24 patients (75%) were managed withmoderate to severe COVID-19 infection. 16 (50%) patients were discharged having been successfully managed in the community, 13 (41%) were admitted and 3 (9%) died having been managed as being in the last stages of life. Fourweeks after discharge from our care, only 2 patients were admitted to hospital or re-referred to Torfaen CRT and no patients were diagnosed with VTE. Conclusions and Implications Half of patients with COVID-19 infection were successfully managed at home under Torfaen CRT. Here we discuss the framework used by our team to structure a multidisciplinary approach to manage these patients in the community and the need for robust evidence to guide management of patients with COVID-19 infection in this setting. Avenues for further research may includevalidating a HaH admission score for patients with COVID-19 infection and determining the evidence base for recommendations such as VTE prophylaxis and treatment with systemic corticosteroids in the communit