• Fahad Razak, Saeha Shin, Frances Pogacar, Hae Young Jung, Laura Pus, Andrea Moser, Lauren Lapointe-Shaw, Terence Tang, Janice L Kwan, Adina Weinerman, Shail Rawal, Vladyslav Kushnir, Denise Mak, Danielle Martin, Kaveh G Shojania, Sacha Bhatia, Payal Agarwal, Geetha Mukerji, Michael Fralick, Moira K Kapral, Matthew Morgan, Brian Wong, ChanTimothy C YTCYDivision of General Internal Medicine (Razak, Verma), St. Michael's Hospital; Department of Medicine (Razak, Moser, Lapointe-Shaw, Tang, Kwan, Weinerman, Rawal, Shojania, Bhatia, Mukerji, Kapral, Morgan, Verma), University of Toronto; Li, and Amol A Verma.
• Division of General Internal Medicine (Razak, Verma), St. Michael's Hospital; Department of Medicine (Razak, Moser, Lapointe-Shaw, Tang, Kwan, Weinerman, Rawal, Shojania, Bhatia, Mukerji, Kapral, Morgan, Verma), University of Toronto; Li Ka Shing Knowledge Institute (Razak, Shin, Pogacar, Jung, Kushnir, Mak, Fralick, Chan, Verma), St. Michael's Hospital; Department of Mechanical and Industrial Engineering (Pogacar, Chan), University of Toronto; Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Pus, Martin, Bhatia, Agarwal, Mukerji), Women's College Hospital; Baycrest Geriatric Health Care System (Moser); Division of General Internal Medicine (Lapointe-Shaw, Rawal, Fralick), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Kwan, Fralick, Morgan), Mount Sinai Hospital; Sunnybrook Health Sciences Centre (Weinerman, Shojania, Wong); Department of Family and Community Medicine (Martin, Agarwal), University of Toronto, Toronto, Ont. fahad.razak@mail.utoronto.ca.
• CMAJ Open. 2020 Jul 1; 8 (3): E514-E521.

BackgroundThe 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.MethodsWe 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.ResultsThere 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.InterpretationThe 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.Copyright 2020, Joule Inc. or its licensors.

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