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

Alboksmaty, Ahmed; Beaney, Thomas; Elkin, Sarah; Clarke, Jonathan; Darzi, Ara; Aylin, Paul; Neves, Ana-Luísa

doi:10.1016/s2589-7500(21)00276-4

Cited by 61 publications

(63 citation statements)

References 69 publications

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“…Remote monitoring technologies have been widely used in the management chronic diseases, but with mixed evidence of their effectiveness24 and limited evidence for their use in COVID-19 with which to compare our findings 25. A pilot study of four NHS COVID-19 pulse oximetry programmes in England indicated the pathway was safe, but did not include a control group 5.…”

Section: Discussionmentioning

confidence: 85%

Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design

et al. 2022

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BackgroundTo identify the population-level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home (CO@h)) in England on mortality and health service use.MethodsWe conducted a retrospective cohort study using a stepped wedge pre-implementation and post-implementation design, including all 106 Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme. All symptomatic people with a positive COVID-19 PCR test result from 1 October 2020 to 3 May 2021, and who were aged ≥65 years or identified as clinically extremely vulnerable were included. Care home residents were excluded. A pre-intervention period before implementation of the CO@h programme in each CCG was compared with a post-intervention period after implementation. Five outcome measures within 28 days of a positive COVID-19 test: (i) death from any cause; (ii) any ED attendance; (iii) any emergency hospital admission; (iv) critical care admission and (v) total length of hospital stay.Results217 650 people were eligible and included in the analysis. Total enrolment onto the programme was low, with enrolment data received for only 5527 (2.5%) of the eligible population. The period of implementation of the programme was not associated with mortality or length of hospital stay. The period of implementation was associated with increased health service utilisation with a 12% increase in the odds of ED attendance (95% CI: 6% to 18%) and emergency hospital admission (95% CI: 5% to 20%) and a 24% increase in the odds of critical care admission in those admitted (95% CI: 5% to 47%). In a secondary analysis of CO@h sites with at least 10% or 20% of eligible people enrolled, there was no significant association with any outcome measure.ConclusionAt a population level, there was no association with mortality before and after the implementation period of the CO@h programme, and small increases in health service utilisation were observed. However, lower than expected enrolment is likely to have diluted the effects of the programme at a population level.

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Section: Discussionmentioning

confidence: 85%

Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design

et al. 2022

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“…The MVW brought benefits for patients, healthcare professionals, and the hospital system. It offered monitoring and reassurance for pregnant women positive for COVID-19, peace of mind for obstetricians, with a mean length of stay shorter than the national average reported in home oximetry for COVID-19 (6.0 vs. 12.7 days) and an escalation rate to inpatient care of 6.6% [11]. However, as the pandemic disrupted the normal schedule of antenatal care in the UK, it was also a route to antenatal services for women who were self-isolating, vulnerable, or otherwise struggling to access care.…”

Section: Discussionmentioning

confidence: 99%

“…In their evaluation of NHS Virtual Ward programs, Alboksmaty et al noted the importance of adequate infrastructure and human resources to staff the program, patient education, and appropriate alarm thresholds, alongside the need to report escalation rates [11]. We would build on this by recommending that clinical pathways should include triage criteria, triggers for escalation, pre-agreed admitting locations, and allocation of responsibility for patients at each stage.…”

Section: Discussionmentioning

confidence: 99%

“…Alarms should be set to balance sensitivity with specificity, as false alarms can be more laborious and disruptive to resolve when the patient is remote. Reported approaches have included fixed thresholds for resting (typically 92%) and post-exertional (> 3-5% decrease) SpO 2 [11]. In the MVW alarm settings, a time window of 60 min, and combination alarms from multiple vital sign parameters were added to improve specificity in continuous monitoring alarms, to ensure that any alerts reflected the patient's true physiological state and not a temporary derangement from activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-pandemic, virtual wards had been shown to reduce mortality in heart failure, and they were widely deployed in COVID-19 at the behest of NHS England [9,10]. A recent review found evidence for the effectiveness of virtual wards deploying pulse oximetry alone to be limited, though only one study of maternity patients was included in the analysis [11]. Indeed, while current clinical practice guidelines for management of COVID-19 in pregnancy vary, there remains general consensus that women should be monitored at home if possible, and hospitalised only in the case of respiratory distress, elevated respiratory rate or low oxygen saturation [12].…”

Section: Introductionmentioning

confidence: 99%

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Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

Bircher

Wilkes²,

Zahradka³

et al. 2022

BMC Pregnancy Childbirth

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Background During the SARS-CoV-2 (COVID-19) pandemic, routine antenatal care was disrupted, and pregnant women positive for COVID-19 were at increased risk of caesarean section, intensive care admission or neonatal unit admission for their baby. Virtual care and telehealth can reduce barriers to care and improve maternity outcomes, and adoption has been encouraged by health authorities in the United Kingdom. Methods Norfolk and Norwich University Hospitals Trust deployed a flexible maternity virtual ward (MVW) service using the Current Health platform to care for pregnant women during the pandemic. Patients were monitored either intermittently with finger pulse oximetry or continuously with a wearable device. We outline the MVW technology, intervention and staffing model, triage criteria and patient feedback, as an example of an operational model for other institutions. Results Between October 2021 and February 2022, 429 patients were referred, of which 228 were admitted to the MVW. Total bed-days was 1,182, mean length of stay was 6 days (SD 2.3, range 1–14 days). Fifteen (6.6%) required hospital admission and one (0.4%) critical care. There were no deaths. Feedback alluded to feelings of increased safety, comfort, and ease with the technology. Conclusions The MVW offered a safety net to pregnant women positive for COVID-19. It provided reassurance for staff, while relieving pressures on infrastructure. When setting up similar services in future, attention should be given to identifying clinical champions, triage criteria, technology and alarm selection, and establishing flexible escalation pathways that can adapt to changing patterns of disease.

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AI-Based mHealth App for Covid-19 or Cardiac Diseases Diagnosis and Prognosis

Vieira

Elvas

Ferreira

et al. 2023

Lecture Notes in Networks and Systems

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

Cited by 61 publications

References 69 publications

Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design

Population-level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design

Remote care and triage of obstetric patients with COVID-19 in the community: operational considerations

AI-Based mHealth App for Covid-19 or Cardiac Diseases Diagnosis and Prognosis

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