How Dutch initiatives to early discharge COVID-19 patients were organised during the pandemic: a scoping review

INTRODUCTION: The steep rise in hospital admissions during the COVID-19 pandemic put a strain on available resources and provision of adequate healthcare globally. Translocation of care to the home setting through early discharge with remote monitoring has the potential to relieve pressure on the hospital care system, reduce costs and could simultaneously benefit patients' well-being.

OBJECTIVE: Provide an overview of similarities, differences and outcomes of early discharge initiatives for COVID-19 patients in the Netherlands to foster future development of safe and effective 'hospital at home interventions'.

DESIGN: Grey and academic literature searches from 1 March 2020 to 1 December 2024 to identify initiatives that discharged COVID-19 patients early through a remote monitoring intervention.

SETTING: The Netherlands.

PARTICIPANTS AND INTERVENTIONS: Hospitals that initiated an early discharge programme for COVID-19 patients.

PRIMARY AND SECONDARY OUTCOME MEASURES: We descriptively compared the available protocols to identify similarities and differences in the execution of the early discharge process. Next, we compared clinical outcomes as reported in available publications and retrieved from post-publication follow-up data collection.

RESULTS: We retrieved 15 protocols (55.6%) and six publications (5 retrospective cohorts, 1 randomised controlled trial) of 27 early discharge initiatives. Two initiatives provided follow-up data. Overall, initiatives were fairly similar, however, with differences in (i) patient selection, (ii) the responsible physician, (iii) the duration and parameters of monitoring and (iv) use of a dedicated monitoring centre. Readmission rates were low, and deaths did not occur except for one initiative (n=8, 3.8%). Patient satisfaction assessed by questionnaires was very high.

CONCLUSION: This study provides insights into the design and potential of early discharge initiatives with remote monitoring launched in the Netherlands during the COVID-19 pandemic. Preliminary data suggest relatively low readmission and mortality rates, and good patient acceptance, but future research should provide definitive conclusions.