Abstract
BackgroundNursing home (NH) residents have been dramatically affected by COVID-19, with extremely high rates of hospitalization and mortality.AimsTo describe the features and impact of an assistance model involving an intermediate care mobile medical specialist team (GIROT, Gruppo Intervento Rapido Ospedale Territorio) aimed at delivering “hospital-at-nursing home” care to NH residents with COVID-19 in Florence, Italy.MethodsThe GIROT activity was set-up during the first wave of the pandemic (W1, March–April 2020) and became a structured healthcare model during the second (W2, October 2020–January 2021). The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2.ResultsThe GIROT activity involved 21 NHs (1159 residents) and 43 NHs (2448 residents) during W1 and W2, respectively. The percentage of infected residents was higher in W2 than in W1 (64.5% vs. 38.8%), while both hospitalization and lethality rates significantly decreased in W2 compared to W1 (10.1% vs 58.2% and 23.4% vs 31.1%, respectively).DiscussionPotentiating on-site care in the NHs paralleled a decrease of hospital admissions with no increase of lethality.ConclusionsAn innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents.
Highlights
Since the first outbreak of coronavirus disease 2019 (COVID-19), nursing homes (NHs) have become epicenters for transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Nursing home (NH) residents have shown disproportionately high risk of contracting the infection [1,2,3,4]
The number of NHs which were struck by SARS-CoV-2 infection and hosted GIROT activity was 21 (1159 residents) and 43 (2448 residents) in the first and second wave, respectively (Table 3)
The percentage of SARS-CoV-2-positive residents was significantly higher in the second wave in comparison with the first one (64.5% vs. 38.8%), while hospitalization rate among SARS-CoV2-positive residents was significantly higher in the first wave than in the second one (58.2% vs 10.1%)
Summary
Since the first outbreak of coronavirus disease 2019 (COVID-19), nursing homes (NHs) have become epicenters for transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and NH residents have shown disproportionately high risk of contracting the infection [1,2,3,4]. In NH residents, hospital admission frequently results in prolonged stays and hospital-related complications such as delirium, infections, malnutrition and functional decline, that negatively impact patients’ prognosis [14,15,16] These complications have been magnified during the COVID-19 pandemic, due to patients’ distress deriving from isolation, loneliness, and staff use of personal protective equipment (PPE) with consequent sensory deprivation [17,18,19]. The activity involved (1) infection transmission control among NHs residents and staff, (2) comprehensive geriatric assessment including prognostication and geriatric syndromes management, (3) on-site diagnostic assessment and protocol-based treatment of COVID-19, (4) supply of nursing personnel to understaffed NHs. To estimate the impact of the GIROT intervention, we reported hospitalization and infection lethality rates recorded in SARS-CoV-2-positive NH residents during W1 and W2. Conclusions An innovative “hospital-at-nursing home” patient-centred care model based on comprehensive geriatric assessment may provide a valuable contribution in fighting COVID-19 in NH residents
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