Remote home monitoring (virtual wards) during the COVID-19 pandemic: a living systematic review

Vindrola-Padros, C.; Singh, K.; Sidhu, M. S.; Georghiou, T.; Sherlaw-Johnson, C.; Tomini, S. M.; Inada-Kim, M.; Kirkham, K.; Streetly, A.; Fulop, N. J.

Objectives: The aim of this review was to analyse the implementation and impact of remote home monitoring models (virtual wards) during COVID-19, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. The review will be kept live through regular updates. Design: The review was designed as a living systematic review to capture a rapidly evolving evidence base. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Setting: The review included remote home monitoring models led by primary and secondary care across seven countries. Participants: 17 examples of remote home monitoring models were included in the review. Main outcome measures: Impact of remote home monitoring on virtual length of stay, escalation, Emergency department attendance, reattendance, admission, readmission and mortality. Results: The primary aim of the remote home monitoring models was the early identification of deterioration for patients self-managing COVID-19 symptoms at home. Most models were led by secondary care. Broad criteria for the eligible patient population were used and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. We could not reach conclusions regarding patient safety and the identification of early deterioration due to lack of standardised reporting across articles and missing data. None of the articles reported any form of economic analysis, beyond how the resources were used. Conclusions: The review pointed to variability in the implementation of the models, in relation to healthcare sector, monitoring approach and selected outcome measures. Lack of standardisation on reporting prevented conclusions on the impact of remote home monitoring on patient safety or early escalation during COVID-19. Future research should focus on staff and patient experiences of care and potential inequalities in access to these models. Attention needs to be paid to the processes used to implement these models, the evaluation of their impact on patient outcomes through the use of comparators, the use of risk-stratification tools, and cost-effectiveness of the models and their sustainability. Protocol registration: The review protocol was published on PROSPERO (CRD: 42020202888).