PMC:7536903 / 6792-10760
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7536903","sourcedb":"PMC","sourceid":"7536903","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7536903","text":"Supporting each other\nWe support our own HITH team and our colleagues by treating everyone with respect and kindness, inclusion, regular communication, understanding of natural anxiety, reassurance and advocacy for infection protection for them in their role as front‐line carers.\n\nClinical role of HITH for COVID‐19\nThe clinical role of HITH will depend on the pathways that already exist and what capacity the HITH service has to expand or modify services and to develop new pathways.\n\nProvision of safe effective HITH care to meet increased hospital demand\nDuring a pandemic, the first priority is to optimise current care. However, there may be opportunities to think about the role of HITH for more patient groups.\nMaximise referral of usual HITH patients: transferring all cohorts that the institutional HITH usually takes; using communication, education and advertising signage about HITH.\nModify usual care to include additional HITH patients: extension of limits of current patient groups: acuity/severity, referral timing and intervention frequency, without decreasing level of care.\nOpportunities to develop new HITH pathways: development for new patient cohorts and new interventions. HITH societies are well positioned to establish sharing of information across hospitals.\n\nReferral of new patients to HITH with COVID‐19\nThe role of HITH for patients with suspected or confirmed COVID‐19 is untested and likely to evolve. Current case definition criteria should be used: patients with mild disease can go home without HITH, patients with severe disease need hospital admission, and the role of HITH lies in between. HITH may also be a source of reassurance for people who are safe to go home but feel frightened by their diagnosis.\nReferral processes: who will review, relay results and give isolation advice, in and out of hours.\nClinical criteria appropriate for HITH suggested for COVID‐19: these should be based on usual institutional HITH criteria:Requirement for ongoing assessment and/or management for moderate illness, for example, respiratory effort but not needing oxygen, decreased fluid intake, moderate secondary bacterial pneumonia requiring IV antibiotics.\nCOVID‐specific modifications may be considered, for example, tolerance of fevers and/or mild hypoxia in otherwise suitable patients.\nMonitoring those at higher risk of deterioration: those with respiratory/cardiac/oncological co‐morbidities, neonates and elderly should be considered individually.\nDuration of HITH admission: symptoms should be clearly improving before discharge; deterioration may occur beyond day 5 of the illness.\nAdditional interventions that may increase use of HITH: depending on HITH capability: equipment kits for patient self‐observation, nasogastric/intravenous hydration, oxygen using concentrators and remote monitoring.\n\nMode of HITH care for patients with COVID‐19\nMode of care depends on patient medical needs and risk of transmission of COVID‐19 infection.\nTelehealth for assessment/review: if no clinical intervention required; also semi‐urgent review of new symptoms or potential need to escalate care.\nIn‐person assessment: if intervention, for example, intravenous antibiotics required, or clinical examination for deterioration alerted by telehealth or patient/family phone call.\nResponsive mobile unit: consideration for ability to respond to need for an in‐person visit after a telehealth review.\n\nTransfer from HITH back to hospital of deteriorating patients with COVID‐19\nUse of standard procedure for escalation of care for deteriorating patients: contact numbers and signs to watch out for on information provided to the patient.\nConsideration of specific criteria in COVID‐19 patients: worsening respiratory status, for example, oxygen saturations \u003c92%; poor urinary output or other clinical concerns.\nTransfer back to hospital: clear process for both in hours and after hours, including where and by which team patient will be 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