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A Rapid Guidance Summary from the

Penn Medicine Center for Evidence-based Practice

Last updated March 31, 2020 8:00 pm  All links rechecked March 30 unless otherwise noted.

Key questions answered in this summary

  • What criteria should be used during follow-up of COVID-19 patients discharged to home care to instruct them to return to the hospital or clinic for reevaluation?

Management of patients who have not been previously been diagnosed with COVID-19 infection is outside the scope of this report.

Summary of major recommendations

Recommendation

Rating

Existing guidelines consistently instruct at-home patients to call their health care provide if their symptoms worsen,
but do not give criteria for recalling those patients to the hospital or clinic.

NA

Hospital policies and algorithms lacked specific criteria for recalling patients after discharge.

NA

Key: A–consistently recommended in multiple guidelines, B–recommended in a single guideline, recommended only in hospital policy documents, or recommended weakly, C–guideline recommendations lacking or inconsistent.

Definition of terms

Guideline:  Guidance developed by a professional society or government agency, intended for use at multiple hospitals.

Policy:  Guidance developed at a hospital for use at that hospital.  It may be based on guidelines or on expert opinion.

Guidelines on criteria for recalling home care patients

Source

Recommendations

CDC

March 30

No relevant guidelines

WHO

March 30

No relevant guidelines

ECDC

March 30

No relevant guidelines

Public Health England

March 30

No relevant guidelines

Public Health Agency of Canada

March 30

No relevant guidelines


Hospital algorithms for recalling home care patients

Source

Criteria

Specific to discharged patients


None

Appplicable to all home-care patients

Beth Israel

March 19

“Red flag” symptoms:

• Worsening cough/shortness of breath or difficulty breathing

• Heart rate over 100 beats/minute

• Persistent chest or abdominal pain

• Persistent significant fevers

• Inability to hydrate or eat appropriately, decreased urine output

• Confusion

• Inability to care for oneself at home

NOTE: these are not specifically identified as criteria for recalling patient, but are signs
that the patient may progress to more severe illness. 

No relevant information: Brigham, Nebraska, UCSF, Washington, Zhejiang

NOTE: There is ample guidance for instructing patients to call the clinic or call center if their symptoms worsen after being sent home.  Guidance for managing those patients who do call is lacking. 

NOTE: Some hospitals are using a standard standard EPIC instruction set titled SPUDISCHARGECOVIDPOSITIVE.  It appears to be a set of instructions to be given to the patient and not a workflow for managing patients after discharge.

About this report

A Rapid Guidance Summary is a focused synopsis of recommendations from selected guideline issuers and health care systems, intended to provide guidance to Penn Medicine providers and administrators during times when latest guidance is urgently needed.  It is not based on a complete systematic review of the evidence.  Please see the CEP web site for further details on the methods for developing these reports. 

Lead analyst: Matthew D. Mitchell, PhD (CEP)

Evidence team: Emilia J. Flores, PhD, RN (CEP); Kirstin A. Manges, PhD, RN (NCS);
Shazia M. Siddique, MD (CEP)

Reviewers: Nikhil K .Mull, MD (CEP)
Nina R. O’Connor, MD (Penn Medicine at Home)

©2020 Trustees of the University of Pennsylvania

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