An Outpatient Model of Care for COVID-19 Infected Kidney Transplant Patients - The Hospital-at-Home

Nephrology (Carlton). 2023 Mar 5. doi: 10.1111/nep.14155. Online ahead of print.

ABSTRACT

BACKGROUND: The COVID-19 pandemic is protracted and episodic surges from viral variants continue to place significant strain on healthcare systems. COVID-19 vaccines, antiviral therapy and monoclonal antibodies have significantly reduced COVID-19 associated morbidity and mortality. Concurrently, telemedicine has gained acceptance as a model of care and a tool for remote monitoring. These advances allow us to safely transit our inpatient-based care for COVID-19 infected kidney transplant recipients (KTRs) to a hospital-at-home (HaH) model of care.

METHODS: KTRs with PCR-proven COVID-19 infection were triaged by teleconsult and laboratory tests. Suitable patients were enrolled into the HaH. Remote monitoring via teleconsults were conducted daily until patients were de-isolated based on a time-based criterion. Monoclonal antibodies were administered in a dedicated clinic where indicated.

RESULTS: Eighty-one KTRs with COVID-19 were enrolled into the HaH between February and June 2022, 70 (86.4%) completed HaH recovery without complications. Eleven (13.6%) patients required inpatient hospitalisation for medical issues (n=8) and weekend monoclonal antibody infusion (n=3). Patients requiring inpatient hospitalisation had longer transplant vintage (15 years vs 10 years, p = 0.03), anaemia (haemoglobin 11.6g/dL vs 13.1g/dL, p = 0.01), lower eGFR (39.8 vs 62.9ml/min/1.73m2, p<0.05) and lower RBD levels (<50AU/ml vs 1435AU/ml, p = 0.02). HaH saved 753 inpatient patient-days with no deaths observed. Hospital admission rates from the HaH programme was 13.6%. Patients who required inpatient care had direct access admission without utilisation of emergency department resources.

CONCLUSIONS: Selected KTRs with COVID-19 infection can be safely managed in a HaH programme; alleviating strain on inpatient and emergency healthcare resources.

PMID:36872077 | DOI:10.1111/nep.14155