Referral of new patients to HITH with COVID‐19
The 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.
Referral processes: who will review, relay results and give isolation advice, in and out of hours.
Clinical 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.
COVID‐specific modifications may be considered, for example, tolerance of fevers and/or mild hypoxia in otherwise suitable patients.
Monitoring those at higher risk of deterioration: those with respiratory/cardiac/oncological co‐morbidities, neonates and elderly should be considered individually.
Duration of HITH admission: symptoms should be clearly improving before discharge; deterioration may occur beyond day 5 of the illness.
Additional 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.