Reaching out to patients in a pandemic

Northern Health has reinstated a successful COVID-19 telephone monitoring service to support patients in the community who tested positive to coronavirus.

Through the service, nursing staff and allied health staff from community programs monitored Northern Health patients or patients that live in the northern suburbs, who have tested positive to COVID-19 and are recovering at home. The patients are assessed for signs of worsening illness and the service is also aimed to provide a timely identification of worsening symptoms and to prevent unnecessary hospital admissions.

The service went live in July 2020 during Victoria’s second wave of COVID-19, and was closely monitored by La Trobe University researchers Associate Professor Adam Semciw and Dr Rebecca Jessup who worked with Northern Health staff to evaluate the service. The service was suspended in November last year, but was restarted in May after the state’s recent coronavirus outbreak.

Associate Professor Semciw said telehealth had proven to be an important tool for providing services and support during the pandemic.

“Telephone monitoring by trained health professionals is a useful model for ongoing management of patients with a mild COVID-19 illness,” Associate Professor Semciw said.

“We found that hospital teams working with COVID patients via telephone were able to identify and monitor those at risk of prolonged illness. With health systems in many parts of the world under pressure when outbreaks occur, we hope they will use our study and observations to inform the development of remote models of care. This may ultimately reduce the burden, risk and need for patients to attend face-to-face care.”

Associate Professor Semciw said the project also provided the opportunity for himself and Dr Jessup, both established researchers, to support and mentor early career clinician researchers at Northern Health to evaluate new models of care. He said such work facilitates immediate translation of research into practice, which under normal circumstances can take years to occur.

More than 950 patients, who had been notified of a positive COVID-19 result, were referred to the service. At the initial call, consent was gained for the patient to be monitored and a clinical assessment incorporating risk stratification and social and welfare needs assessment was undertaken.

Patients were also provided with education on how to isolate at home and how to identify symptoms of deterioration.

The patients were monitored during the acute phase of their illness, typically up to 14 days. During the service, a telephone call script was used, which included a checklist of risk factors and symptoms. The symptom checklist identified if patients symptoms were worsening and symptoms were categorised as stable or deteriorating. For patients with deteriorating symptoms, escalation of care involved consultation with a Northern Health medical officer, referral to the GP or Emergency Department or calling an ambulance. The service has found great benefit of using the Northern Health Virtual ED program.

High risk patients received daily monitoring calls and low risk patients received second-daily contact.

Patients were discharged from the service when cleared from isolation by the Department of Health. All patients received a post-discharge follow-up telephone call to check on their recovery and patients self-reported any ongoing symptoms and if they had returned to their usual daily activities.

In 2020, 36 per cent of patients were at risk of serious illness and those deemed at risk had two times greater odds of experiencing symptoms 30 days after diagnosis.

Sixteen per cent of patients reported a prolonged illness and of those, fatigue was the most common symptom, with 55 per cent of patients reporting this symptom in this initial 30 day period.

Andrea Clarke, Community Compliance Leader, is one of nine Northern Health staff and the two La Trobe University staff members to author an article on the service’s results in the Journal of Community Health. She said telephone monitoring by trained health professionals has a strong potential in the effective management of patients with a mild COVID-19 illness.

“The publication of this article is a great endorsement of the work done by a team of Northern Health staff in supporting people with COVID-19 during Melbourne’s second wave last year. It is also a personal achievement for me as this is the first article that I have authored,” Andrea said.

“A key to the success of the program was leveraging off our existing systems, processes and expertise. We pulled together staff from different areas and they were able to generalise their skills to this service which was really successful.”

“A big learning from this service was the importance of communication. We had open lines of communication between the patients, front line staff and leadership team and this was vital to our success in standing up a service within 1 week at the peak of the second wave.”

Fiona Beadle, Clinical Nurse Consultant, said the service provided valuable support to the Northern Health community isolating at home with COVID-19.

“Some of these patients have been living alone and feeling the isolation that comes with physical separation from the community,” Fiona said.

“Overwhelmingly, patients have been very grateful for the support provided to them through the program. One patient who has recently been discharged from the program stated, ‘I will miss the regular phone calls’.”

Johanna Hayes, Community Programs Director, said the program restarted this year immediately when the first case was identified.

“Northern Health Community Programs is proud to be involved in the important work of keeping people whom have a diagnosis of COVID-19 well at home. We ran a very successful program last year with over 950 people on the pathway and so far this year 30 people have benefited from the program,” Johanna said.

La Trobe Media Manager | Kathryn Powley | 0456 764 371 | k.powley@latrobe.edu.au

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