How Northwestern Medicine quickly deployed an outpatient COVID-19 monitoring program


Though treating COVID-19 patients who require hospitalization is a key concern for U.S. hospitals, there is also a need to monitor and support coronavirus patients who are caring for themselves at home. Chicago-based Northwestern Medicine mounted an outpatient monitoring program for that very reason, and its leaders described the program and its 10-day implementation in an article published in NEJM Catalyst.

Northwestern Medicine established an outpatient monitoring program for COVID-19 patients that went live March 24 with 50 patients. As of May 21, 6,853 patients had been through the program. It includes hundreds of nurses, advanced practice professionals, medical students and attending physicians caring for patients using an EHR registry.

To create the program, Northwestern's IT staff built an EHR registry and patient questionnaire. Specific clinical criteria were developed for including patients in the registry, including a pending COVID-19 test, a positive or indeterminate COVID-19 test ,or presumed presence of COVID-19 based on certain symptoms and clinical factors. Only nurses from the health system's COVID-19 triage phone line, emergency department staff and hospital medicine staff are able to add patients to the registry.

Patients enrolled in the registry then receive a questionnaire daily at 6 a.m. with several questions, including the date symptoms began, the presence or absence of 10 symptoms and information about the household in which the patient lived.

Responses from the daily symptom questionnaire are used to split patients into two groups: those with mild symptoms and those with concerning symptoms. Nurses, advanced practice professionals and medical students call patients in the group showing concerning symptoms to provide information, determine whether contacting other clinicians might be helpful (such as a primary care physician or specialist), and identify nonclinical issues. They also call those who had not responded by about 11 a.m.

The program operates from 8 a.m. to 8 p.m. seven days a week and involves an average of 90 nurses, advanced practice professionals and medical students who work four-, eight-, or 12-hour shifts. Nine attending physicians per day, working four-hour shifts, provide clinical supervision.

Northwestern Medicine is funding the monitoring program and not billing patients or payers, the leaders wrote.

Health system leaders said they hope the outpatient home monitoring program will provide a prototype for managing other acute illnesses.

Learn more about the program and its implementation here.






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