• Kranthi Sitammagari, Stephanie Murphy, Marc Kowalkowski, Shih-Hsiung Chou, Matthew Sullivan, Stephanie Taylor, James Kearns, Thomas Batchelor, Carly Rivet, Colleen Hole, Tony Hinson, Pamela McCreary, Ryan Brown, Todd Dunn, Zeev Neuwirth, and Andrew McWilliams.
• Atrium Health, Charlotte, North Carolina (K.S., S.M., M.S., S.T., J.K., T.B., C.R., C.H., T.H., P.M., R.B., T.D., Z.N.).
• Ann. Intern. Med. 2021 Feb 1; 174 (2): 192-199.

BackgroundPandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for care innovation.ObjectiveTo describe the development and rapid deployment of a virtual hospital program, Atrium Health hospital at home (AH-HaH), within a large health care system.DesignProspective case series.SettingAtrium Health, a large integrated health care organization in the southeastern United States.Patients1477 patients diagnosed with coronavirus disease 2019 (COVID-19) from 23 March to 7 May 2020 who received care via AH-HaH.InterventionA virtual hospital model providing proactive home monitoring and hospital-level care through a virtual observation unit (VOU) and a virtual acute care unit (VACU) in the home setting for eligible patients with COVID-19.MeasurementsPatient demographic characteristics, comorbid conditions, treatments administered (intravenous fluids, antibiotics, supplemental oxygen, and respiratory medications), transfer to inpatient care, and hospital outcomes (length of stay, intensive care unit [ICU] admission, mechanical ventilation, and death) were collected from electronic health record data.Results1477 patients received care in either the AH-HaH VOU or VACU or both settings, with a median length of stay of 11 days. Of these, 1293 (88%) patients received care in the VOU only, with 40 (3%) requiring inpatient hospitalization. Of these 40 patients, 16 (40%) spent time in the ICU, 7 (18%) required ventilator support, and 2 (5%) died during their hospital admission. In total, 184 (12%) patients were ever admitted to the VACU, during which 21 patients (11%) required intravenous fluids, 16 (9%) received antibiotics, 40 (22%) required respiratory inhaler or nebulizer treatments, 41 (22%) used supplemental oxygen, and 24 (13%) were admitted as an inpatient to a conventional hospital. Of these 24 patients, 10 (42%) required ICU admission, 1 (3%) required a ventilator, and none died during their hospital admission.LimitationGeneralizability is limited to patients with a working telephone and the ability to comply with the monitoring protocols.ConclusionVirtual hospital programs have the potential to provide health systems with additional inpatient capacity during the COVID-19 pandemic and beyond.Primary Funding SourceAtrium Health.

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