Remote Patient Monitoring Identifies the Need for Triage in Patients with Acute COVID-19 Infection

Abstract

Background: Telehealth was frequently used in the provision of care and remote patient monitoring (RPM) during the COVID-19 pandemic. The Precision Recovery Program (PRP) remotely monitored and supported patients with COVID-19 in their home environment. Methods: This was a single-center retrospective cohort study reviewing data acquired from the PRP clinical initiative. Results: Of the 679 patients enrolled in the PRP, 156 patients were screened by a clinician following a deterioration in symptoms and vital signs on a total of 240 occasions, and included in the analyses. Of these 240 occasions, 162 (67%) were escalated to the PRP physician. Thirty-six patients were referred to emergency department, with 12 (7%) admitted to the hospital. The most common risk factors coinciding with hospital admissions were cardiac (67%), age >65 (42%), obesity (25%), and pulmonary (17%). The most common symptoms reported that triggered a screening event were dyspnea/ tachypnea (27%), chest pain (14%), and gastrointestinal issues (8%). Vital signs that commonly triggered a screening event were pulse oximetry (15%), heart rate (11%), and temperature (9%). Discussion: Common factors (risk factors, vital signs, and symptoms) among patients requiring screening, triage, and hospitalization were identified, providing clinicians with further information to support decision making when utilizing RPM in this cohort. Conclusion:A clinician-led RPM program for patients with acute COVID-19 infection provided supportive care and screening for deterioration. Similar models should be considered for implementation in COVID-19 cohorts and other conditions at risk of rapid clinical deterioration in the home setting.

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

“…Few studies have assessed the effect of monitoring patients with pulse oximeters on health outcomes and the use of health-care services. 37 , 67 A prospective trial estimated an almost 50% reduction in unnecessary emergency and hospital readmissions among participants. 44 In a study by Shah and colleagues, 54 33% of participants stated that they would be more likely to visit hospitals, at least for reassurance, if they were not monitored remotely.…”

Discharge from the emergency department and early hospital revaluation in patients with COVID-19 pneumonia: a prospective study

“…A notable strength of all the home protocols was the possibility of measuring patients’ oxygen saturation at home and performing a QWT. More recently, several other studies reported the favorable experience of using telemedicine or remote monitoring in COVID-19 patients, all of which included the home measurement of oxygen saturation with a pulse oximeter [ 20 - 22 ]. For example, in a study by Gootenberg et al [ 20 ] approximately 10% of the patients that were initially discharged from the ED were admitted late to the hospital, as were 7% of them in the study by Tabacof et al [ 22 ] which is a slightly lower rate than in our cohort (17%).…”

Post–Intensive Care Syndrome in Neurocritical Care Patients

“…Leveraging remote physiological monitoring (RPM) and telehealth care to address the longitudinal nature of chronic care across disease populations has significantly increased in recent years, particularly following the COVID-19 pandemic. [162][163][164] RPM is defined as the digital transmission of health data from a patient at home to their healthcare provider in a clinical location. 165,166 The use of RPM saw preliminary larger scale deployment in the management of patients with chronic cardiac and pulmonary conditions, with notable significance in reducing readmissions, reducing mortality rates, detecting clinical deterioration, and optimizing quality of life.…”