RESUMO
The posthospital discharge period is vulnerable for patients with coronavirus disease 2019 (COVID-19). The authors implemented a COVID-19 discharge pathway in the electronic medical record for UCHealth, a 12-hospital health care system, including an academic medical center (University of Colorado Hospital [UCH]), to improve patient safety by standardizing discharge processes for COVID-19 patients. There were 3 key elements: (1) building consensus on discharge readiness criteria, (2) summarizing discharge criteria for disposition locations, and (3) establishing primary care follow-up protocols. The discharge pathway was opened 821 times between April 20, 2020, and June 7, 2020. Of the 436 patients discharged from the hospital medicine service at UCH from April 20, 2020, and June 7, 2020, 18 (4%) were readmitted and 13 (3%) had a 30-day emergency department visit. The main trend observed was venous thromboembolism. This pathway allowed real-time integration of clinical guidelines and complex disposition requirements, decreasing cognitive burden and standardizing care for a complex population.
Assuntos
COVID-19/epidemiologia , Alta do Paciente/normas , Segurança do Paciente/normas , Centros Médicos Acadêmicos , Fatores Etários , Protocolos Clínicos , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Mediadores da Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Medição de Risco , SARS-CoV-2RESUMO
OBJECTIVES: A subset of patients with coronavirus disease 2019 develop renal failure and require continuous renal replacement therapy. We reviewed the available literature to understand the frequency of continuous renal replacement therapy use among patients with coronavirus disease 2019 who required intensive care. DATA SOURCES: The authors reviewed PubMed and Google Scholar for published studies and MedRxiv.com for unpublished studies. STUDY SELECTION: Observational and randomized studies that report the frequency of continuous renal replacement therapy use in adult patients with coronavirus disease 2019. DATA EXTRACTION: Data from the eligible studies were extracted independently by two authors into Microsoft Excel. DATA SYNTHESIS: We identified 12 eligible studies (eight published, four unpublished). We found that up to 20% of patients admitted to ICUs may require continuous renal replacement therapy. CONCLUSIONS: Given the high utilization of continuous renal replacement therapy by critically ill patients with coronavirus disease 2019, there may be an urgent need to mobilize inpatient dialysis resources to cope with the anticipated increase in the demand.