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Effective fast-track ambulatory care pathway for patients with COVID-19 at risk for poor outcome: the COVID-A2R model in a hospital emergency department




Moreno-Pérez O, Ribes I, Fuertes-Kenneally L, Carratalá Perales JM, Román F, Otero-Rodríguez S, González-de la Aleja P, Merino E, Llorens P



Servicio de Endocrinología y Nutrición, Hospital General Universitario de Alicante, Spain. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain. Departamento de Medicina Clínica, Universidad Miguel Hernández, Elche, Spain. Servicio de Medicina Interna, Hospital General Universitario de Alicante, Spain. Servicio de Cardiología, Hospital General Universitario de Alicante, Spain. Servicio de Urgencias, Hospital General Universitario de Alicante, Spain. Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.



Objective. To evaluate the effectiveness of a care pathway (Spanish acronym, COVID-A2R) through which patients with SARS-CoV-2 infection were referred by a hospital emergency department (ED) for fast-track in-person outpatient clinic care if they did not have respiratory insufficiency but were at high risk for complications and poor outcome.
Methods. Retrospective cohort of patients referred to the COVID-A2R pathway after being diagnosed with COVID-19 by reverse transcription polymerase chain reaction assay in a tertiary care hospital ED between January 7 and February 17, 2021. The inclusion criteria were 1) absence of pneumonia but presence of serious comorbidity and/or elevated
biomarkers of inflammation, and 2) pneumonia with or without elevated inflammatory markers but without respiratory insufficiency. The main outcome was need for an emergency department revisit with hospital admission and time from ED evaluation to hospitalization. Secondary outcomes were the number of COVID-A2R visits and the
potential economic impact.
Results. We included 278 patients with a median age of 57 years (57.9% men) and a median Charlson Comorbidity Index of 1. The median time since onset of symptoms was 7 days (interquartile range, 4‚Äď11 days). Pneumonia was
diagnosed in 71.8%, and 64.7% required only 1 in-person visit in the COVID-A2R pathway. No revisits to the ED were needed by 87.8% (83.4%‚Äď91.1%) of the patients. Of the 34 patients who were hospitalized, 88.2% were admitted
within 5 days. The COVID-A2R model potentially saved 1708 days of hospitalization.
Conclusion. The fast-track ambulatory care model was effective after emergency department discharge of patients with COVID-19 without respiratory insufficiency but with clinical or laboratory indicators of risk for poor outcome.


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