HOSPITAL @HOME: TREATING SEVERE COVID-19 IN THE COMMUNITY

Introduction Patient numbers during the second wave of COVID-19 threatened to overwhelm hospital capacity. Hospital @home services bring the ward to the patient;providing acute care in the home, delivered by a specialised multi-disciplinary team. Our Hospital @home was ideally placed to adapt to support the care of COVID patients in the community who would otherwise have required hospitalisation yet were unlikely to benefit from level 2/3 care. Here we report on the process and 30 day outcomes. Methods An evidence-based guideline for the treatment of severe COVID by Hospital @home was developed. A severe bundle pack including dexamethasone, oxygen, IV fluids and thromboprophylaxis was used at first patient contact. Patients were referred from the community or from hospital and streamed into severe or non-severe pathways. Outcome data was retrospectively extracted from the notes of all COVID positive patients admitted to hospital @home between 16/12/2020 and 14/02/2021. Results 125 COVID patients were treated by hospital @home. Patients were triaged by infection severity: severe (n = 42, 34%) and non-severe (n = 83, 66%). Average length of stay with hospital @home was 6.8 days (IQR 4–8);equivalent to 855 occupied bed days—i.e. one 28 bed ward for 30.5 days. 33 patients were treated with the severe COVID bundle with an average Clinical Frailty Score 6.9 (IQR 6–8). 30 day outcomes for patients treated with the severe bundle were: 13 (39%) alive in the community (average CFS 6.2), 1 (3%) in hospital and 19 (57%) deceased (average CFS 7.4). Conclusion Rapid redesign of an existing hospital @home service during the COVID pandemic offered appropriate patients the choice to have Level 1 hospital care in their home. Hospital @home has an essential role in offering alternative pathways of care to patients and optimising local healthcare capacity.

The impact of COVID-19 on research within the homeless services sector

Purpose: This paper aims to discuss the challenges of conducting research with homelessness services frontline workers during the COVID-19 pandemic. Design/methodology/approach: Between 2015 and 2019, the research team surveyed frontline staff in three cities about their psychosocial stressors and needs. In 2020, the authors replicated the previous study and expanded data collection to seven cities across Canada to determine the extent to which the COVID-19 pandemic impacted the well-being of frontline staff. This report describes how the authors adapted the research methodologies to continue work throughout the pandemic, despite various restrictions. Findings: The original studies had very high participation rates because of several methodological approaches that minimized barriers, especially in-person data collection. During the pandemic, distancing requirements precluded replication of these same methods. Research strategies that enabled staff participation during working hours, with designated time allotted for participation, was key for ensuring high participation rates, as access to technology, availability of free time and other factors frequently make online survey research a hardship for these staff. Restrictive interpretation and regional variations of COVID-19 guidelines by some research ethics boards were also a challenge to rapid and responsive data collection. Originality/value: Few studies describe the experiences of frontline workers in the homelessness sector, and quantitative reports of their experiences are particularly scant. Consequently, little is known about specific methodologies that facilitate large-scale data collection in the homelessness services sector. The present research advances the field by providing lessons learned about best practice approaches in pre and post COVID-19 front line worker contexts. A strength of this research is the well-controlled design. The authors collected data within several of the organizations that had previously participated. This fortunate baseline provided opportunity for comparison before and during the pandemic;the authors can highlight factors that might have had influence during the pandemic. © 2021, Jeannette Waegemakers Schiff, Eric Paul Weissman, Deborah Scharf, Rebecca Schiff, Stephanie Campbell, Jordan Knapp and Alana Jones.

Pandemic preparedness and response in service hub cities: lessons from Northwestern Ontario

Purpose - Responding to the needs of homeless and marginally housed persons has been a major component of the Canadian federal and provincial responses to the COVID-19 pandemic. However, smaller, less-resourced cities and rural regions have been left competing for limited resources (Schiff et al., 2020). The purpose of this paper is to use a case study to examine and highlight information about the capacities and needs of service hub cities during pandemics. Design/methodology/approach - The authors draw on the experience of Thunder Bay - a small city in Northern Ontario, Canada which experienced a serious outbreak of COVID-19 amongst homeless persons and shelter staff in the community. The authors catalogued the series of events leading to this outbreak through information tracked by two of the authors who hold key funding and planning positions within the Thunder Bay homeless sector. Findings - Several lessons may be useful for other cities nationally and internationally of similar size, geography and socio-economic position. The authors suggest a need for increased supports to the homeless sector in small service-hub cities (and particularly those with large Indigenous populations) to aid in the creation of pandemic plans andmore broadly to ending chronic homelessness in those regions. Originality/value - Small hub cities such as Thunder Bay serve vast rural areas andmay have high rates of homelessness. This case study points to some important factors for consideration related to pandemic planning in these contexts.