RT Journal Article
SR Electronic
T1 Modelling resource requirements and physician staffing to provide virtual urgent medical care for residents of long-term care homes: a cross-sectional study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E514
OP E521
DO 10.9778/cmajo.20200098
VO 8
IS 3
A1 Fahad Razak
A1 Saeha Shin
A1 Frances Pogacar
A1 Hae Young Jung
A1 Laura Pus
A1 Andrea Moser
A1 Lauren Lapointe-Shaw
A1 Terence Tang
A1 Janice L. Kwan
A1 Adina Weinerman
A1 Shail Rawal
A1 Vladyslav Kushnir
A1 Denise Mak
A1 Danielle Martin
A1 Kaveh G. Shojania
A1 Sacha Bhatia
A1 Payal Agarwal
A1 Geetha Mukerji
A1 Michael Fralick
A1 Moira K. Kapral
A1 Matthew Morgan
A1 Brian Wong
A1 Timothy C.Y. Chan
A1 Amol A. Verma
YR 2020
UL http://www.cmajopen.ca/content/8/3/E514.abstract
AB Background: The coronavirus disease 2019 (COVID-19) outbreak increases the importance of strategies to enhance urgent medical care delivery in long-term care (LTC) facilities that could potentially reduce transfers to emergency departments. The study objective was to model resource requirements to deliver virtual urgent medical care in LTC facilities.Methods: We used data from all general medicine inpatient admissions at 7 hospitals in the Greater Toronto Area, Ontario, Canada, over a 7.5-year period (Apr. 1, 2010, to Oct. 31, 2017) to estimate historical patterns of hospital resource use by LTC residents. We estimated an upper bound of potentially avoidable transfers by combining data on short admissions (≤ 72 h) with historical data on the proportion of transfers from LTC facilities for which patients were discharged from the emergency department without admission. Regression models were used to extrapolate future resource requirements, and queuing models were used to estimate physician staffing requirements to perform virtual assessments.Results: There were 235 375 admissions to general medicine wards, and residents of LTC facilities (age 16 yr or older) accounted for 9.3% (n = 21 948) of these admissions. Among the admissions of residents of LTC facilities, short admissions constituted 24.1% (n = 5297), and for 99.8% (n = 5284) of these admissions, the patient received laboratory testing, for 86.9% (n = 4604) the patient received plain radiography, for 41.5% (n = 2197) the patient received computed tomography and for 81.2% (n = 4300) the patient received intravenous medications. If all patients who have short admissions and are transferred from the emergency department were diverted to outpatient care, the average weekly demand for outpatient imaging per hospital would be 2.6 ultrasounds, 11.9 computed tomographic scans and 23.9 radiographs per week. The average daily volume of urgent medical virtual assessments would range from 2.0 to 5.8 per hospital. A single centralized virtual assessment centre staffed by 2 or 3 physicians would provide services similar in efficiency (measured by waiting time for physician assessment) to 7 separate centres staffed by 1 physician each.Interpretation: The provision of acute medical care to LTC residents at their facility would probably require rapid access to outpatient diagnostic imaging, within-facility access to laboratory services and intravenous medication and virtual consultations with physicians. The results of this study can inform efforts to deliver urgent medical care in LTC facilities in light of a potential surge in COVID-19 cases.