Brief Communications Reengineering the Discharge Transition Process of COVID-19 Patients Using Telemedicine, Remote Patient Monitoring, and Around-the-Clock Remote Patient Monitoring from the Emergency Department and Inpatient Units Rich Kodama, DO, 1 Sunny Arora, MD, MPH, 1 Swati Anand, MD, 1 Abu Choudhary, MD, 1 Jeremy Weingarten, MD, 1 Notar Francesco, MD, 1 Gerardo Chiricolo, MD, 2 Steven Silber, DO, 2 and Parag H. Mehta, MD 1 Departments of 1 Medicine and 2 Emergency Medicine, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, USA. Abstract Background: At the beginning of the COVID-19 pandemic, New York City quickly became the epicenter with hospitals at full capacity needing to care for patients. At New York Presbyterian Brooklyn Methodist Hospital, we needed to develop an innovative system of how to safely discharge the massive influx of patients. Inundation of patient care with limited manpower and resources forced us to align with a third-party vendor, around-the-clock alert, to make remote patient monitoring (RPM) possible. Each patient was pre- scribed a pulse oximeter and nurses were assigned to monitor vital signs, speak to patients, and escalate to physicians if required. Results: We enrolled 50 patients, of whom 13 were escalated resulting in 3 emergency room visits and 1 readmission. We had a high compliance rate with high patient satisfaction in postsurveys. Discussion: Our program was unique in that it utilized tele- medicine for regular patient follow-up, along with RPM through a third-party vendor. Patients were able to be safely discharged home with close follow-up through regularly ob- tained vitals with access to a 24/7 hotline for any emergen- cies, possibly preventing readmissions. Limitations include a small sample size population. Conclusions: Our experience shows that in a short period despite lack of resources, telehealth and RPM’s concurrent use with a third-party vendor could be successfully utilized for safe discharges with high patient satisfaction. Keywords: telemedicine, telehealth, COVID, pandemic, home health monitoring, cardiovascular disease Objective T o describe the evolution of processes that enabled early safe Emergency Department and hospital discharges and follow-up of low- and moderate- risk COVID-19 patients, using limited clinical staff, to expand hospital capacity to accommodate the massive influx of high-risk and critically ill patients. Background As of July 21, 2020, over 14.7 million COVID-19 cases worldwide were confirmed with over 3.8 million of them in the United States. 1 The first case of community spread of the COVID-19 was identified in New York City on March 1, 2020. New York City became the epicenter within the United States with 221,703 confirmed cases and 23,411 deaths. 2 This stret- ched the bed capacity of all New York City Hospitals to the limit in a very short time. Innovative contingency plans such as de- ploying the USNS Comfort to New York Harbor, and turning the Jacob K. Javitz Convention Center into a field hospital were employed to meet the demand. Brooklyn is the most-populous borough in New York City with an estimated 2,648,403 residents in 2020. It was particu- larly overwhelmed with 61,488 confirmed cases and 7,206 deaths. 2 NewYork-Presbyterian Brooklyn Methodist Hospital (NYPBMH) is a large, 651-bed, major teaching hospital affili- ated with the Weill Cornell Medical College, and is a member of the NewYork-Presbyterian Healthcare System. At NYPBMH, we were equally inundated with the surge. Our intensive care unit, which is usually 40 beds, expanded to 200 beds having to convert areas such as ambulatory surgery, pediatric ward, endoscopy suite, and psychiatry unit to accommodate the surge. There have been *1,850 COVID-19 admissions with the average daily census between April 1 and May 10, 2020; out of 200–385 COVID-19-positive inpatients, 80–108 patients required mechanical ventilation. Respiratory complications and rapid deterioration of COVID-19 patients were common, devastating, and unpre- dictable. There were no reliable indicators to foresee who would progress into the cytokine storm phase. This uncer- tainty created angst and worry among caregivers. Reports of 1188 TELEMEDICINE and e-HEALTH ª MARY ANN LIEBERT, INC.  VOL. 27 NO. 10  OCTOBER 2021 DOI: 10.1089/tmj.2020.0459 Downloaded by 35.175.192.15 from www.liebertpub.com at 10/15/21. For personal use only.