Analysis of an Ambulatory Care Pathway for Patients With COVID-19 Utilising Remote Pulse Oximetry at a London District General Hospital

Abstract

The identification of coronavirus disease 2019 (COVID-19) patients with oxygen saturations between 90-94% who can be safely discharged from the emergency department (ED) is challenging due to the difficulty of community monitoring. A pathway consisting of home pulse oximetry with telephone follow-up was devised and implemented at a London District General Hospital to facilitate the safe discharge of these patients from the ED. Twenty patients with confirmed or suspected COVID-19 with oxygen saturations between 90%-94% were discharged on this novel ambulatory care pathway. Eighty-five percent of patients successfully avoided hospitalisation, whilst 15% were re-assessed and subsequently admitted to hospital. Home pulse oximetry monitoring was utilised to aid discharge from the ED and therefore prevent hospital admission. Telephone follow-up identified patients requiring further assessment. This study demonstrates the potential for safe ambulation of a subgroup of patients with COVID-19.

Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review

“…13 studies with a combined total of 2908 participants were included in our systematic review ( table 1 ). 14 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 All participants had either confirmed or presumptive COVID-19, except for 12 healthy individuals who acted as a control group in one study by Motta and colleagues. 45 Another study by Gordon and colleagues 44 involved a control group of patients with COVID-19 who were not given pulse oximeters for remote monitoring.…”

“…One study 44 scored seven stars on the NOS tool, indicating good quality. Seven studies 14,45–50 scored five or six stars, indicating fair quality, whereas five studies 51 , 52 , 53 , 54 , 55 scored four or fewer stars. The absence of a control group in most of the studies negatively influenced the quality by scoring zero out of two stars in the comparability aspect of the NOS tool.…”

The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: a national observational study using hospital activity data

“…Managed by primary and secondary care providers, the services aimed to safely manage patients -identified from within the community, from Emergency Departments (ED), or following hospital discharge -outside of hospital, to provide reassurance and rapid escalation where necessary. [1][2][3][4][5][6][7] Similar remote home monitoring programmes were also developed in several other countries. 8 During England's second COVID-19 wave in November 2020, the NHS in England launched a national roll out of community-based home monitoring services under the banner of 'COVID Oximetry @ home' (CO@h).…”

“…Occasionally these are considered against a perceived optimal level (for example, a 10% conversion rate to admissions for ambulatory care pathways 2 ), or the reported performance of services elsewhere. [1][2][3][4]7,20,21 Data on which patients were enrolled to CVWs in England was not collected, but information was assembled on launch dates of CVW at each hospital trust. By late February 2021 the large majority of acute hospital trusts in England had a service available for use.…”

“…Occasionally these are considered against a perceived optimal level (for example, a 10% conversion rate to admissions for ambulatory care pathways 2 ), or the reported performance of services elsewhere. 1–4,7,20,21…”