Bed Availability Research Articles

985 The Impact of COVID-19 on Cardiac Surgery Services at a Tertiary Cardiac Surgery Centre in the UK

Abstract Aim This project aims to assess the impact of COVID-19 on cardiac surgery services at one UK tertiary cardiac surgery centre. Method Data was collected from 2nd January 2020 to 1st April 2021. Three timeframes were selected, each encapsulating a 9-week period: pre-COVID (2nd January 2020 to 28th February 2020), during the first wave (Peak 1: 23rd March 2020 to 22nd May 2020, where peak infection date is 22nd April 2020), during the second wave (Peak 2: 30th November 2020 to 29th January 2021, where peak infection date is 29th December 2020). The data comprised of number of operations performed and cancelled, including cancellations due to lack of critical care bed availability. Mean and standard error was calculated in Microsoft Excel. Results The results show a substantial reduction in the service provided, with the average number of operations performed per week decreasing from 15.8 during the pre-COVID timeframe to 3.2 during the first wave, and 7.6 during the second. There was a greater percentage of cancellations due to lack of critical care beds during the first wave (50%) and the second wave (35%), compared to pre-COVID (34%). Conclusions During this pandemic, many health services, including tertiary cardiac surgery centres, were faced with significant burden, and forced to shift focus towards managing an unknown disease. This cardiac surgery department has adapted admirably and is gradually resuming to normal service. It is vital that insight gained from this pandemic is maintained and utilised to develop guidelines to improve and prepare services for future unprecedented events.

896 The Effect of a Simple Intervention on Emergency Department Breaches in Trauma and Orthopaedics Patients: A Multi-Cycle Audit in a District General Hospital

Abstract Aim We present a re-audit of Emergency Department (ED) waiting times following an intervention to improve surgical bed flow with the aim of further reducing the number of Trauma and Orthopaedics (T&O) patients that breached the four-hour wait target. Method An initial two-cycle closed-loop audit of ED waiting times of patients admitted under T&O was undertaken. Protocols were updated and new guidelines were synthesised and implemented in collaboration between the ED and T&O departments. This intervention reduced the number of patients that breached in ED and identified bed availability as the primary cause of these breaches. A third cycle was done. Posters were placed in key prescribing areas of the T&O department, detailing the need for ‘to take-out’ (TTO) prescriptions ‘to be completed before 15:00 as after this time pharmacy will not dispense the prescription’. Data was collected retrospectively from clinical e-documentation. P-values were calculated by Fishers Exact test. Results 57 patients were included in cycle 1 and 51 patients in cycle 2. ED breaches reduced from cycle 1 to cycle 2: 86% to 65% respectively (p < 0.05). In cycle 3, 42 patients were included, and breaches increased to 67% of patients, representing no significant change from cycle 2 (p > 0.05). The number of breaches due to a shortage of hospital beds increased from 45% in cycle 2 to 75% in cycle 3 (p < 0.05). Conclusion Bed shortages remained the main cause for T&O admissions to breach in ED. Earlier completion of TTO prescriptions did not solve the problem.

Aspect-Based Sentiment Analysis of Online Reviews for Business Intelligence

COVID-19 pandemic has affected the patients to a large extent who are in immediate need of medical care. Now-a-days people rely on online reviews shared on review websites to gather information about hospitals like the availability of beds, availability of ventilators etc. However, these reviews are large in number and unstructured which makes it difficult to interpret them. Hence, the authors have proposed a methodology that will apply an aspect based sentiment analysis on the reviews to gain meaningful insights of the hospital based on different aspects like doctor, staff, facilities etc. For the purpose of empirical validation, a total of 26,071 reviews pertaining to 325 hospitals were scrapped. The authors concluded that the study can be useful for patients as it helps them to select the hospital which best suits them. The study also helps hospital administration to improve the current services according to needs of the patients.

Impact of a same day admission project in reducing the preoperative bed occupancy demand in a pediatric inpatient hospital

BackgroundA same day admission approach was established for pediatric patients undergoing elective surgery owing to an increase in demand for bed availability and the need for medical, logistical, psychological, and fiscal improvements. This study aimed to assess the effectiveness of the same day admission approach for reducing demand for preoperative bed occupancy in pediatric inpatient units. MethodData on elective surgery patients considered for same day admission were prospectively collected in an Excel spreadsheet. ResultsSame day admission patients numbered 269 (25.87%; n = 1040), 461 (41.7%; n = 1104), 382 (38.67%; n = 998), and 560 (44.20%; n = 1267) in 2018, 2019, 2020, and 2021, respectively. Over the 4-year period between 2018 and 2021, pediatric orthopedic surgeries accounted for the majority of same day admissions (29.72%; n = 497), followed by ear, nose, and throat (21.30%; n = 356), general (16.99%; n = 284), plastic (14.53%; n = 243); urology (9.87%; n = 165); optometry and ophthalmology (3.77%; n = 63); neuro (2.51%; n = 42), and dental (1.31%; n = 22) surgeries. The total number of days of saved preoperative beds over the 4-year period was 1672 days (an average of 418 hospital days per year). ConclusionsThis study showed that same day admission approach should be implemented in pediatrics institutions to reduce hospital bed demand. The implementation of this initiative is widely variable between specialties due to interlinked medical, operational, and logistical factors. Level of EvidenceIII.

Indicators of familialism and defamilialization in long-term care: A theoretical overview and introduction of macro-level indicators

Many countries have been working on revising their long-term care (LTC) policies to meet the increasing demand for care. Generally, little attention is paid to the potential (unintended) consequences of LTC policies for inequality among care users or informal caregivers. Saraceno previously explicitly argued that differences in care use and provision depend on the type of LTC policy, and that policies with contrasting consequences for inequality can be implemented at the same time. We call upon future research to empirically test the impact of different types of LTC policies on socio-economic inequalities in care. To stimulate and facilitate such research, our aims are to outline theoretical arguments for the differential impact of LTC policies on socio-economic inequalities in care and to create macro-level indicators for different types of supportive LTC policies in European countries over time. Our study’s research question is: Can we find and capture different dimensions of LTC policies in macro-level indicators that are comparable over countries and time? In particular, we focus on supported familialism (for example, informal caregiver support), supported defamilialization through the market (for example, in-cash benefits for care users), and defamilialization through public provision (for example, availability of beds in residential care). Besides a summary of the literature on LTC policies and how they may affect socio-economic inequalities in care, we outline our search process for macro-level LTC indicators and present descriptive information on the different types of LTC policies and their correlations. We discuss the difficulties that arise when translating theoretical insights about different types of LTC policies into high-quality measures for many countries and time points.

Post Anesthesia Response Unit: Development of an Intensive Care Unit within a Post Anesthesia Care Unit

Background InformationDuring the COVID-19 pandemic, the bed availability in Intensive Care Unit's (ICU) at Strong Memorial Hospital was limited. The Post Anesthesia Care Unit (PACU) was able to help load balance the intensive care units (ICU's) by caring for 6 ICU patients utilizing a team nursing model.Objectives of ProjectThe goal of the Post Anesthesia Response Unit (PARU) development was to utilize a team nursing model successfully caring for ICU patients. Because not all of the nurses who work within the PACU are traditionally trained to care for ICU patients, perioperative services leadership wanted to provide comprehensive ICU care by pairing the few ICU trained nurses with added support staff for safe patient care.Process of ImplementationThe PACU converted the extended recovery area into separate areas to care for ICU patients indefinitely. Leadership identified items that were critical in caring for ICU patients, worked alongside the hospital supply chain on creating a supply room, and built a code cart specifically for the PARU. The PARU scheduler paired an in-patient PACU RN who had prior knowledge working in an ICU with an assistive RN creating a buddy pairing. This paring was maintained throughout the entirety of the PARU and had a patient ratio of two patients to one pairing. Focusing on the PACU RN's skillset and knowledge base, leadership was able to identify staff member to care for individuals either receiving surgery or the chronic ICU population.Statement of Successful PracticePARU leadership found by having an ambulatory nurse or nurse anesthetists paired with a PACU nurse, a team nursing model approach was successful. The PACU nurses delegated tasks appropriately to their supportive staff member for safe patient care. PARU was open for total of 46 days caring for chronic surgical ICU patients. There was a total of 26 patients: 11 patients transitioned to floor level of care. 2 patients transitioned to comfort measures only. 2 patients were discharged to long term ventilator care units. 6 patients returned to the ICU's. Through collaborative efforts, ICU patients were able to be cared for by a nurse pairing in a safe comprehensive manner.Implications for Advancing the Practice of Perianesthesia NursingThe second surge of the COVID-19 pandemic caused an influx of critically ill patients. Perioperative leadership recognized the opportunity to help load balance the patient population by having 6 patients be cared for within the PACU setting. We learned that PACU nurses can successfully and confidently care for a two patient ICU assignment by utilizing a team nursing model.

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

Boarding for Youth Mental Health Conditions: How Can Hospitalists Be Part of the Solution?

P20 Pre-operative checklist to improve pathway for carotid endarterectomy (CEA) patients: a single centre audit

Abstract Introduction The SARS-COV-2 pandemic has led to the redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOP) was proposed. An audit was undertaken to evaluate the SOP, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements. Methods To ascertain key pre-operative steps to include in the checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once the checklist was established the questionnaire was re-sent additionally asking for feedback on its impact on the service and suggestions for improvement. Using these results, the checklist was incorporated as a smart text to EPIC (electronic patient notes). Results The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt the checklist improved the service in all domains, except bed availability and subsequent surgical delay, likely because this depended on HDU bed availability and need for on-the-day prioritisation. Conclusion The CEA surgery checklist is now an established part of the electronic patient record in the form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of the team including new/temporary staff can follow this, ensuring a safe care pathway. Take-home message With the move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by the use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.

A prospective randomised low dose finding study of preservative free 1% cloroprocaine in spinal anesthesia for perineal surgeries

Ambulatory surgery has become popular in this era which has resulted in the advent of newer short acting anaesthetic drugs to suit early ambulation of post operative patients and discharge and early resumption of daily activities. This in turn reduces cost of care, increased availability of beds for sick patients, lower risk of resistant bacterial strain transmission and faster return to work and social activities., This study was aimed to find out the effective low dose of 1% chloroprocaine for lower limb ambulatory surgeries performed as day care procedures. 93 consented patients were randomized to three groups of 31 each to receive 20 mg, 25 mg and 30mg of 1%chloroprocineintrathecally. Sensory and motor block was assessed.: The collected data was analysed using IBM.SPSS statistics23.0 Version.The demographic data in all three groups were comparable. The onset of motor blockade was profound in patients receiving 30 mg of chloroprocaine compared to 20 or 25 mg. The blook persisted for longer duration with delayed voiding of urine, delay in unassisted ambulation inpatients receiving 30 mg of 1% chloroprocaine.

When Outcomes Diverge: Age and Cardiovascular Risk as Determinants of Mortality and ICU Admission in COVID-19.

Background: Hospital mortality and admission to the Intensive Care Unit (ICU) are markers of disease severity in COVID-19 patients. Cardiovascular co-morbidities are one of the main determinants of negative outcomes. In this study we investigated the impact of cardiovascular co-morbidities on mortality and admission to the ICU in first-wave COVID-19 patients. Methods: A multicenter, retrospective, cohort study. A total of 1077 patients were analyzed for mortality and ICU admission. Cardiovascular risk factors were explored as determinants of the outcomes after correction for other confounders. Results: In the multivariable model, after correction for age, only a history of heart failure remained independently associated (p = 0.0013) with mortality (hazard ratio 2.22, 95% confidence interval 1.37 to 3.62). Age showed a mortality risk increase of 8% per year (hazard ratio 1.08, 95% confidence interval 1.05 to 1.10, p = 0.001). The transition from ward to the ICU had, as a single determinant, the age, but in a reversed fashion (hazard ratio 0.96, 95% confidence interval 0.94 to 0.98, p = 0.0002). Conclusions: Once adjusted for the main determinant of mortality (age) heart failure only remained independently associated with mortality. Admission to the ICU was less likely for elderly patients. This may reflect the catastrophic impact of the first wave of COVID-19 pandemic in terms of ICU bed availability in Lombardy, leading to a selection process for ICU admission.

Radiofrequency ablation for management of thyroid nodules in quarantine zone of COVID-19 pandemic setting in Indonesia

Surgery using minimally invasive procedures has been continuously developing in the medical field including in the treatment and resection of thyroid tumors. In addition to open thyroid surgery, several types of procedures are well developed and adopted in our center including the endoscopic thyroid and radiofrequency ablation (RFA). The COVID-19 pandemic has substantially changed the healthcare system in Indonesia. Lack of oxygen and hospital wards, unaffordable screening tests, and limited health workers affect the perpetuation of non-emergency healthcare service including in the management of thyroid nodules. To preserve the resources needed during the pandemic, PFA for the thyroid procedure provides a better option in terms of hospital bed availability, healthcare cost, and patients’ emotional distress. We safely conducted RFA procedures during the period of quarantine levels of 1–3 (low to high) by implementing COVID-19 protocols without any significant postoperative complications.

Integrated enhanced cognitive behavioural (I-CBTE) therapy significantly improves effectiveness of inpatient treatment of anorexia nervosa in real life settings

BackgroundInpatient treatment of anorexia nervosa can be lifesaving but is associated with high rates of relapse and poor outcomes. To address this, the Oxford service has adapted the enhanced cognitive behavioural treatment (CBTE) model, first developed for inpatients in Italy to a UK national health service (NHS) setting. In this study, we compared the outcomes from treatment as usual (TAU), integrated CBTE (I-CBTE), and alternative treatment models in routine UK clinical practice.MethodsThis is a longitudinal cohort study, using routinely collected data between 2017 and 2020 involving all adults with anorexia nervosa admitted to specialist units from a large geographical area in England covering a total population of 3.5 million. We compared TAU with (1) I-CBTE (13 weeks inpatient CBTE, restoration to a healthy weight, combined with 7 weeks day treatment followed by 20 weeks of outpatient CBTE; (2) standalone inpatient CBTE (due to insufficient resources since the pandemic; and (3) 6–8 weeks admission with partial weight restoration as crisis management. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: (1) good outcome: Body Mass Index (BMI) > 19.5 and no abnormal eating or compensatory behaviours; (2) poor outcome: BMI < 19.5 and/or ongoing eating disorder behaviours; (3) readmission; or (4) deceased. Secondary outcomes were BMI on discharge, and length of stay.Results212 patients were admitted to 15 specialist units in the UK depending on bed availability. The mean age was 28.9 (18–60) years, mean admission BMI was 14.1 (10–18.3), 80% were voluntary. At minimum 1-year follow up after discharge, 70% of patients receiving I-CBTE and 29% standalone inpatient CBTE maintained good outcomes, in contrast with < 5% TAU and crisis management admission. Readmission rates of I-CBTE were 14.3% vs ~ 50% (χ2 < 0.0001) in the other groups. The main predictors of good outcome were reaching healthy BMI by discharge, I-CBTE and voluntary status. Age, psychiatric comorbidity and length of stay did not predict outcomes. BMI on discharge and length of stay were significantly better in the CBTE groups than in TAU.ConclusionsOur main finding is that in a real-life setting, I-CBTE has superior short- and minimum 1 year outcomes as compared with alternative inpatient treatment models. Dissemination of I-CBTE across the care pathway has the potential to transform outcomes of inpatient treatment for this high-risk patient population and reduce personal and societal costs.

An Experience as a Medical Support during the COVID-19 Pandemic.

COVID-19 pandemic; medical students; telehealth; volunteerism.

Calculation of the need for resources of the health care system to provide palliative care to the population of Ukraine in 2018–2020

Financing of the needs of the health care system of Ukraine at the current stage takes place in the form of payment for packages of contracted services by the National Health Service of Ukraine. One of these packages is palliative and hospice care (PHC). In the professional environment, there is a debate about the composition of this package and the amount of funding. The right to PHC is one of the important components of the general right of Ukrainians to health care, and it must be ensured both from the point of view of medical ethics and to fulfill Ukraine's international obligations. The calculation of the amount of PHC financing is carried out in accordance with the data of demographic statistics (in particular, the number of available adult population and children aged 0–14), the calculated number of patients who need PHC, the availability of hospices, palliative departments and beds, as well as the possibility of their creation/deployment, presence of field (mobile) PHC teams, which should provide approximately 60% of such assistance. The study calculated the need for the Ukrainian PHC system in personnel and material resources: the number of palliative departments and beds, mobile teams, doctors and nurses, for the period 2018–2020. It was established that the minimum and optimal number of required palliative departments during this period ranged from 83 to 257 for adults and 19 to 66 for children, the number of required beds was (1,136–1,434) and (576–629), outpatient (mobile) services – (259–517) and (59–396), inpatient doctors – (215–285) and (118–52), inpatient nurses – (568–1,720) and (104–944), doctors of mobile teams – (518–2,066) and (118–1,582), nurses of mobile teams – (518–6,197) and (118–4,746), respectively. Factors that can cause calculation errors (specificity of treatment and prevention facilities in the regions, the presence of palliative patients in a small number who should be provided with help at home), other limitations of the study are established. Keywords: hospices, mobile palliative care services, human resources, contracted medical services.

Experience and results after the implementation of a radiology day unit in a reference hospital

BackgroundInterventional radiological procedures have significantly increased in recent years. Most of them are minimally invasive and require a short hospitalization, mainly done in other non-radiological units nowadays. Limited bed availability and high occupancy rates in these units create longer waiting lists and cancellations. The aim of this retrospective study is to assess the creation and functioning of a Radiology Day Unit (RDU) and evaluating its outcomes. For this purpose, data about interventional procedures and its complications, incidents, patient safety, quality and satisfaction rates were collected from May 2018 to December 2020, and posteriorly analyzed to evaluate its implementation.ResultsDuring the assessed period, 3841 patients were admitted into the RDU, with a net increase of 13% and 26% in the second and third year, respectively. Procedures performed by the Abdominal Radiology section were the most frequent (76–85%) followed by Interventional Vascular Radiology and Thoracic Radiology. Complication rates were low (1.5%) and most of them were self-limited and managed in the own department. Waiting lists were significantly reduced, from 2 months to 1 week in case of procedures performed by the Abdominal Radiology section. Patient satisfaction was higher than 80% in all the items evaluated with a global satisfaction of 93%.ConclusionThe RDU in our hospital has become a vital section for the management and post-procedure caring of patients undergoing interventional procedures in the Radiology Service with low complication rates and overall high levels of quality and patient safety, allowing the reduction of waiting lists and occupancy rates.

Dynamics of indicators of bed fund of offices of anesthesiology and resuscitation in the Russian Federation

Introduction. Efficient bed fund management is one of the most important conditions for an appropriate management of healthcare provision. The aim of the study is to analyze the trend in anesthesiologic and intensive care unit bed capacity in federal districts (FD) and subjects of the Russian Federation for 2014-2018. Material and methods. We analyzed the indicators of intensive care beds use (availability of beds to population, hospitalization rate, duration of patient’s stay in intensive care bed, occupancy, bed turnover, mortality) according to federal statistical observation - forms No. 14 and No. 30. Results. In Russia, the provision of beds in the health care sector has been decreasing over the last decade. At the same time, resuscitation beds were not affected by such changes, and from 2014 to 2018 the number of resuscitation beds tended to increase by 80.8%, which is associated, among other things, with the changes in the methodology of formation of the annual reporting form №30. The following changes in indicators of intensive care beds use were revealed in the trend in the Russian Federation as a whole for 2014-2018: the hospitalization rate slightly increased by 28.6% (from 0.5 to 0.7); provision of the population with intensive care beds (per 10,000 population) tends to increase by 45.8% population) tends to increase by 45.1% (from 1.1 to 2.0); length of stay of the patient on average increased by 23.9% (from 7.0 to 9.2 days); average occupancy (bed work) tends to decrease from 254 to 247 days; bed turnover tends to decrease from 36.1 to 26.9; mortality rate increases from 30.2 to 46.9%. Limitations. The results of the study of the dynamics of anesthesiologic and intensive care unit bed capacity are only valid for the Federal districts and Federal subjects of the Russian Federation. Conclusions. Additional studies are needed to further objectivize the assessment of ICU bed utilization efficiency.

Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study.

BackgroundDelayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care.MethodsA descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007–2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student’s T test and Pearson’s chi-square test (χ2) were used.ResultsA total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.

Double-Staged Sleeve Resection of Laryngotracheal Tumor of Papillary and Follicular Thyroid Carcinoma.

Advanced thyroid carcinoma involving the upper aerodigestive tract confers a poor prognosis mainly due to airway complications. The management of thyroid carcinoma with infiltration to the aerodigestive tract has been widely discussed with no consensus regarding the best surgical technique. Complete surgical resection is the aim of the surgery. However, it has high morbidity if the postsurgical care is compromised, which will lead to airway obstruction, bleeding, infection, and anastomotic dehiscence. In our center, complete resection was achieved through cricotracheal window resection with partial closure and tracheostomy tube insertion. This procedure was chosen due to the time-sensitive nature of surgery in these patients with airway compromise and postoperative limitation of intensive care unit (ICU) bed availability. In our case series, we present six cases of papillary and follicular thyroid carcinoma complicated with intraluminal laryngotracheal infiltration and discuss its management and outcome.

Impact on the incidence of gastrointestinal perforation during the COVID-19 pandemic in the Costa del Sol healthcare system area

Introduction and aimsGastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. Materials and methodsA retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. ResultsThe study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137 h. Hospital stay increased by 5 days and delay in care increased 4.5 h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. ConclusionsDuring the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

Impact of Remote Patient Monitoring on Length of Stay for Patients with COVID-19.

Background: Remote patient monitoring (RPM) can be deployed as part of a tiered approach to open up hospital bed availability by allowing earlier discharge of patients with continued virtual monitoring. We describe the impact of RPM on length of stay (LOS) for patients with COVID-19. Methods: We deployed RPM during two COVID-19 surges at a tertiary academic hospital from March to June 2020 as a feasibility pilot to establish the infrastructure for RPM including electronic health record changes and virtual health center (VHC) protocols, and October 2020 to February 2021, during the second surge of COVID-19. Discharging patients received a wearable vital sign monitoring device, allowing real-time data transmission to the VHC using a smart phone application. The data, monitored 24 h a day for 8 days by a technician, had built-in escalation protocols to nurses and/or attending physicians. Results: We compared patients discharged with RPM with those discharged without RPM during both phases using a two-to-one-matched case-control design including age, sex, Charlson comorbidity index, and limited English proficiency. After including discharge with home oxygen therapy as an effect modifier, there was a significant association between shorter LOS and RPM for patients discharging without home oxygen (p = 0.0075) compared with patients not discharging on RPM. Discussion: Our study shows a strong association between a reduction in LOS for patients discharging with RPM but without home oxygen therapy, which can assist with hospital capacity. Conclusions: Home telemonitoring after discharge for patients with COVID-19 may reduce LOS.