Background/Aims Although remote patient monitoring systems are rapidly emerging, much has concentrated on managing chronic rather than acute conditions. British Thoracic Society (BTS) guidelines on acute community acquired pneumonia (CAP) suggest not all patients with CURB65 scores 0 to 2 need hospital inpatient treatment and, with the alternative of a supervised environment, we report post hoc analysis of what was initially a proof of concept model adopting a Telehealth enabled system as a potentially effective option designed to reduce hospital length of stay (LOS).
Methods Over 1 year to May 2011, 138 patients (60 male, 78 female) with mean (SD, range) age 65.5 (18.7, 19–95) years were admitted with CAP were identified. Selection for Telehealth was guided by initial CURB65 scores, patient competence/compliance with technology, social considerations and geographical factors as the provision was only within the area supported by Telford & Wrekin (T&W) PCT; patients were declined while on intravenous antibiotics. Remote monitoring (blood pressure, heart rate, respiratory rate, oxygen saturation, temperature) was via a Broomwell Health system (wrist watch concept) with twice daily planned data downloads managed and triaged through a HUB system filtering recordings to community based nurses. Data on LOS were skewed and non-parametric analysis of median (IQ) values undertaken to compare outcomes by area.
Results Abstract S63 table 1 shows raw data by age, sex, and LOS (days). 85% had CURB65 scores 0 to 2 and 17 (12.3%) died (8 had higher CURB65 scores). 33/138 (24%) were managed using Telehealth (majority CURB65 0–1) representing 35.5% from the T&W area. Comparing groups as a whole showed significantly (p<0.05) lower (median, IQ) LOS (days) for T&W (4, 2–8) vs the rest (6, 4–9). Differences in initial CURB65 scores, age and sex distribution between groups were not statistically significant when considering those patients with CURB65 0–2 where again LOS was reduced for T&W (n=75) at 4 (2–7) vs the rest (n=42) at 6 (3.8–9.3). None on Telehealth died but one had an unrelated admission.
Conclusion We have shown the proof of concept in adopting this technology in managing acute CAP and although we provide additional evidence to demonstrate reduction in length of stay, more controlled studies with economic models and an assessment of the return on investment are required. Most of the observed benefit seems to stem from more actively managing and discharging patients with lower CURB65 scores but who nevertheless presented as acute hospital admissions and subsequently benefited from the same provisions offered by Telehealth.