Insights From Rapid Deployment of a "Virtual Hospital" as Standard Care During the COVID-19 Pandemic

Ann Intern Med. 2021 Feb;174(2):192-199. doi: 10.7326/M20-4076. Epub 2020 Nov 11.


Background: Pandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for care innovation.

Objective: To describe the development and rapid deployment of a virtual hospital program, Atrium Health hospital at home (AH-HaH), within a large health care system.

Design: Prospective case series.

Setting: Atrium Health, a large integrated health care organization in the southeastern United States.

Patients: 1477 patients diagnosed with coronavirus disease 2019 (COVID-19) from 23 March to 7 May 2020 who received care via AH-HaH.

Intervention: A virtual hospital model providing proactive home monitoring and hospital-level care through a virtual observation unit (VOU) and a virtual acute care unit (VACU) in the home setting for eligible patients with COVID-19.

Measurements: Patient demographic characteristics, comorbid conditions, treatments administered (intravenous fluids, antibiotics, supplemental oxygen, and respiratory medications), transfer to inpatient care, and hospital outcomes (length of stay, intensive care unit [ICU] admission, mechanical ventilation, and death) were collected from electronic health record data.

Results: 1477 patients received care in either the AH-HaH VOU or VACU or both settings, with a median length of stay of 11 days. Of these, 1293 (88%) patients received care in the VOU only, with 40 (3%) requiring inpatient hospitalization. Of these 40 patients, 16 (40%) spent time in the ICU, 7 (18%) required ventilator support, and 2 (5%) died during their hospital admission. In total, 184 (12%) patients were ever admitted to the VACU, during which 21 patients (11%) required intravenous fluids, 16 (9%) received antibiotics, 40 (22%) required respiratory inhaler or nebulizer treatments, 41 (22%) used supplemental oxygen, and 24 (13%) were admitted as an inpatient to a conventional hospital. Of these 24 patients, 10 (42%) required ICU admission, 1 (3%) required a ventilator, and none died during their hospital admission.

Limitation: Generalizability is limited to patients with a working telephone and the ability to comply with the monitoring protocols.

Conclusion: Virtual hospital programs have the potential to provide health systems with additional inpatient capacity during the COVID-19 pandemic and beyond.

Primary funding source: Atrium Health.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • COVID-19 / therapy*
  • Female
  • Home Health Nursing / methods*
  • Home Health Nursing / organization & administration
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Pandemics
  • Patient Acuity
  • Personnel Staffing and Scheduling
  • Prospective Studies
  • SARS-CoV-2
  • Southeastern United States
  • Telemedicine / methods*
  • Telemedicine / organization & administration
  • Workflow
  • Young Adult