Abstract
To optimize patient outcomes and preserve critical acute care access during the COVID-19 pandemic, the Los Angeles County Department of Health Services developed the SAFE @ HOME O2 Expected Practice (expected practice), enabling ambulatory oxygen management for COVID-19. To assess outcomes of patients with COVID-19 pneumonia discharged via the expected practice approach to home or quarantine housing with supplemental home oxygen. This retrospective cohort study included 621 adult patients with COVID-19 pneumonia who were discharged from 2 large urban public hospitals caring primarily for patients receiving Medicaid from March 20 to August 19, 2020. Patients were included in the analysis cohort if they received emergency or inpatient care for COVID-19 and were discharged with home oxygen. Patients receiving at least 3 L per minute of oxygen, stable without other indication for inpatient care, were discharged from either emergency or inpatient encounters with home oxygen equipment, educational resources, and nursing telephone follow-up within 12 to 18 hours of discharge. Nurses provided continued telephone follow up as indicated, always with physician back-up. All-cause mortality and all-cause 30-day return admission. A total of 621 patients with COVID-19 pneumonia (404 male [65.1%] and 217 female [34.9%]) were discharged with home oxygen. Median age of these patients was 51 years (interquartile range, 45-61 years), with 149 (24.0%) discharged from the emergency department and 472 (76%) discharged from inpatient encounters. The all-cause mortality rate was 1.3% (95% CI, 0.6%-2.5%) and the 30-day return hospital admission rate was 8.5% (95% CI, 6.2%-10.7%) with a median follow-up time of 26 days (interquartile range, 15-55 days). No deaths occurred in the ambulatory setting. In this cohort study, patients with COVID-19 pneumonia discharged on home oxygen had low rates of mortality and return admission within 30 days of discharge. Ambulatory management of COVID-19 with home oxygen has an acceptable safety profile, and the expected practice approach may help optimize outcomes, by ensuring right care in the right place at the right time and preserving access to acute care during the COVID-19 pandemic.
Highlights
As presented by the Institute for Healthcare Innovation, a fundamental principle of high quality patient-centered care is to provide the right care in the right place at the right time.1 This practice enhances patient safety by transitioning patients to outpatient care as soon as there are no conditions that require acute inpatient care
No deaths occurred in the ambulatory setting. In this cohort study, patients with COVID-19 pneumonia discharged on home oxygen had low rates of mortality and return admission within 30 days of discharge
The median age of the cohort was 51 years, and consistent with the general population served by both hospitals, patients were primarily insured by Medicaid (76%) and Spanish-speaking (84%)
Summary
As presented by the Institute for Healthcare Innovation, a fundamental principle of high quality patient-centered care is to provide the right care in the right place at the right time.. As presented by the Institute for Healthcare Innovation, a fundamental principle of high quality patient-centered care is to provide the right care in the right place at the right time.1 This practice enhances patient safety by transitioning patients to outpatient care as soon as there are no conditions that require acute inpatient care. In March 2020, recognizing the need to provide real-time decision support on a global pandemic for a workforce of approximately 22 000 employees, the LA County DHS created a new library of EPs devoted to the evaluation and management of COVID-19. An important aspect of ensuring patient safety and maintaining hospital access during the pandemic was the establishment and implementation of an EP about use of home oxygen to enable earlier discharges
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