The impact of remote home monitoring of people with COVID-19 using pulse oximetry: A national population and observational study

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Abstract

Background

Remote home monitoring of people testing positive for COVID-19 using pulse oximetry was implemented across England during the Winter of 2020/21 to identify falling blood oxygen saturation levels at an early stage. This was hypothesised to enable earlier hospital admission, reduce the need for intensive care and improve survival. This study is an evaluation of the clinical effectiveness of the pre-hospital monitoring programme, COVID oximetry @home (CO@h).

Methods

The setting was all Clinical Commissioning Group (CCG) areas in England where there were complete data on the number of people enrolled onto the programme between 2nd November 2020 and 21st February 2021. We analysed relationships at a geographical area level between the extent to which people aged 65 or over were enrolled onto the programme and outcomes over the period between November 2020 to February 2021.

Findings

For every 10% increase in coverage of the programme, mortality was reduced by 2% (95% confidence interval:4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1·8% (-1·2% to 4·9%). None of these results are statistically significant, although the confidence interval indicates that any adverse effect on mortality would be small, but a mortality reduction of up to 4% may have resulted from the programme.

Interpretation

There are several possible explanations for our findings. One is that CO@h did not have the hypothesised impact. Another is that the low rates of enrolment and incomplete data in many areas reduced the chances of detecting any impact that may have existed. Also, CO@h has been implemented in many different ways across the country and these may have had varying levels of effect.

Funding

This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research programme (RSET Project no. 16/138/17; BRACE Project no. 16/138/31) and NHSEI. NJF is an NIHR Senior Investigator.

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Most cited references 24

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Rapid Implementation of a COVID-19 Remote Patient Monitoring Program

Tucker Annis, Susan Pleasants, Gretchen Hultman … (2020)

Abstract Objective To evaluate early lessons from a remote patient monitoring engagement and education technology solution for patients with COVID-19 symptoms. Materials and Methods A COVID-19-specific remote patient monitoring solution (GetWell Loop) was offered to patients with COVID-19 symptoms. The program engaged patients and provided educational materials and the opportunity to share concerns. Alerts were resolved through a virtual care workforce of providers and medical students. Results Between March 18 and April 20, 2020, 2,255 of 3,701 (60.93%) patients with COVID-19 symptoms enrolled resulting in over 2,303 alerts, 4,613 messages, 13 hospital admissions, and 91 emergency room visits. A satisfaction survey was given to 300 patient respondents, 74% of whom would be extremely likely to recommend their doctor. Discussion This program provided a safe and satisfying experience for patients while minimizing COVID-19 exposure and in-person healthcare utilization. Conclusion Remote patient monitoring appears to be an effective approach for managing COVID-19 symptoms at home.

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Pulse Oximetry for Monitoring Patients with COVID-19 at Home. Potential Pitfalls and Practical Guidance

Andrew Luks, Erik Swenson (2020)

During the ongoing coronavirus disease (COVID-19) pandemic, reports in social media and the lay press indicate that a subset of patients are presenting with severe hypoxemia in the absence of dyspnea, a problem unofficially referred to as “silent hypoxemia.” To decrease the risk of complications in such patients, one proposed solution has been to have those diagnosed with COVID-19 but not sick enough to warrant admission monitor their arterial oxygenation by pulse oximetry at home and present for care when they show evidence of hypoxemia. Though the ease of use and low cost of pulse oximetry makes this an attractive option for identifying problems at an early stage, there are important considerations with pulse oximetry about which patients and providers may not be aware that can interfere with successful implementation of such monitoring programs. Only a few independent studies have examined the performance of pocket oximeters and smart phone–based systems, but the limited available data raise questions about their accuracy, particularly as saturation falls below 90%. There are also multiple sources of error in pulse oximetry that must be accounted for, including rapid fluctuations in measurements when the arterial oxygen pressure/tension falls on the steep portion of the dissociation curve, data acquisition problems when pulsatile blood flow is diminished, accuracy in the setting of severe hypoxemia, dyshemoglobinemias, and other problems. Recognition of these issues and careful counseling of patients about the proper means for measuring their oxygen saturation and when to seek assistance can help ensure successful implementation of needed monitoring programs.

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Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review

Cecilia Vindrola-Padros, Kelly E Singh, Manbinder S. Sidhu … (2021)

Background the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. Methods we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. The search was updated on February 2021. We used the PRISMA statement and the review was registered on PROSPERO (CRD: 42020202888). Findings the review included 27 articles. The aim of the models was to maintain patients safe in the appropriate setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/career training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored. Interpretation future research should focus on staff and patient experiences of care and inequalities in patients’ access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools.

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Author and article information

Journal

Journal ID (nlm-ta): EClinicalMedicine

Journal ID (iso-abbrev): EClinicalMedicine

Title: EClinicalMedicine

Publisher: The Authors. Published by Elsevier Ltd.

ISSN (Electronic): 2589-5370

Publication date PMC-release: 1 March 2022

Publication date (Electronic): 1 March 2022

Electronic Location Identifier: 101318

Affiliations

[a ]Nuffield Trust, 59 New Cavendish Street, London, Northern Ireland W1G 7LP, United Kingdom

[b ]Department of Public Health and Primary Care, University of Cambridge, Northern Ireland, United Kingdom

[c ]College of Medical and Dental Sciences, University of Birmingham, Institute of Applied Health Research, 40 Edgbaston Park Rd, Birmingham, Northern Ireland B15 2RT, United Kingdom

[d ]Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Rd, Birmingham, Northern Ireland B15 2RT, United Kingdom

[e ]Department of Applied Health Research, University College London, Gower Street London, Northern Ireland WC1E 6BT, United Kingdom

[f ]Department of Targeted Intervention, Charles Bell House, University College London, 43-45 Foley Street, London, Northern Ireland W1W 7TY, United Kingdom

Author notes

[* ]Corresponding author.

Article

Publisher Item ID: S2589-5370(22)00048-7 Publisher ID: 101318

DOI: 10.1016/j.eclinm.2022.101318

PMC ID: 8886180

PubMed ID: 35252824

SO-VID: 48166ea9-932c-4313-8074-34805895ca7c

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 10 December 2021

Date revision received : 3 February 2022

Date accepted : 8 February 2022

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