Nearly two years since COVID-19 first appeared, there are more tools than ever before to tackle the pandemic, including highly effective vaccines and a much better understanding of the disease and its treatments. Now, too, we have the evidence to show that a trio of bright ideas implemented at Penn Medicine to provide the right care in the right places have saved lives and greatly improved the way we care for patients with COVID-19.

The COVID-19 Triage Tool

Released at the height of the spring 2020 surge, the COVID-19 Triage Tool was developed to give patients an easy, effective way to determine what level of care (if any) they may need in response to COVID-19 exposure or symptoms. It was also designed to ease the burden on health care providers by steering patients with mild cases away from emergency departments and escalating sicker patients to the right level of care.

A study in Applied Clinical Informatics noted that the Triage Tool, which comprised a Frequently Asked Questions page and an automated chatbot, categorized the overwhelming majority of patients who used it into the appropriate severity level. For those patients whose symptoms warranted immediate attention, the tool, integrated into Penn Medicine’s systems, directed them where to turn for next steps, instead of toward a call center which would only have to repeat the screening. The researchers say symptom-checking tools like this – whether for COVID or another health crisis – should both improve patients’ experience and safely free up call centers and clinicians to attend to the patients who are most in need.

COVID Watch

A study recently published in the Annals of Internal Medicine described the tremendous success of another Penn-born tool, COVID Watch. This automated text messaging system provides continual monitoring of patients with a COVID-19 diagnosis through twice-daily check-ins. When patients indicate in reply to an automated text that they have worsening symptoms, they are sent follow-up questions and put directly in touch with a nurse staffing the program who can direct them to the hospital, if needed.

Researchers found that use of the system helped save lives, as often as one life every three to four days. COVID Watch also demonstrated equity and efficacy among different populations. “We saw a higher proportion of higher-risk patients and also low-income and Black patients enrolled in COVID Watch, but the fact that we measured a significant benefit associated with enrollment in the program is a good indicator that there truly is a treatment benefit for everyone,” said the study’s lead author and co-primary investigator, M. Kit Delgado, an assistant professor of emergency medicine and epidemiology, as well as the deputy director of the Penn Medicine Nudge Unit.

The COVID Accelerated Care Pathway

When patients are hospitalized with COVID-19, they don’t always need to be in an ICU on ventilator support. In fact, some just require a day or two of inpatient care to stabilize before they can be discharged to ride out the rest of the illness at home, with monitoring. This idea was the foundation of the COVID Accelerated Care Pathway (CACP), which debuted at the Hospital of the University of Pennsylvania almost exactly one year ago, and which was described in a new analysis in the American Journal of Managed Care.

The CACP helps clinicians determine which patients can be admitted briefly to observation units and then safely return home, which frees up beds for sicker patients, increases efficiency, reduces readmission rates, and aids in recovery. Patients cleared for discharge are followed up with via COVID Watch (or COVID Pulse, which employs a pulse oximeter for remote monitoring). According to Keith Hemmert, medical director of HUP’s emergency department, “Identifying these patients early in their encounter with the health system allowed us to set them on a trajectory toward early discharge to home, and meanwhile allowed us to prioritize the right resources for patients who were seriously ill with COVID-19.”