COVID Oximetry @home and Virtual Wards
‘Right care in the right place’
As part of the COVID response, two national projects have been launched: COVID Oximetry @home in November and COVID Virtual wards in January.
Both projects aim to provide extra support for patients suffering from COVID-19 to enable them to be safety cared for in their own homes.
What is Covid Oximetry @ home?
COVID Oximetry @home models have been established to provide patients with a means of monitoring their own blood oxygen level (with a pulse oximeter) in their own homes. The aim of the model is to support patients with symptomatic COVID-19 infection who do not require hospital admission but would be considered at greater risk of deterioration. Use of pulse oximetry (non-invasive blood oxygen monitoring), provides the opportunity to detect a potential decline in a patient’s condition before they develop worsening symptoms and as such enable timely clinical review and appropriate treatment.
The service has five key stages:
Patients are referred into the service from a variety of providers e.g. GP Practices. The scheme is not open to everyone with a positive COVID-19 test but is based on an assessed clinical need.
Patients referred to the service will be clinically assessed for suitability to join and there is a discussion with the patient about their support requirements.
Patients entering the service are provided with a pulse oximeter and supporting information to facilitate its correct use and ensure the accuracy of any readings submitted. Patients are given clear information on when and how to seek further clinical advice or assessment should blood oxygens levels fall below set thresholds or they develop symptoms suggestive of deterioration.
The level and type of monitoring being offered will be discussed with the patient and agreed. There will be checks in place to confirm that the patient is using the oximeter and diary correctly.
Patients who remain symptomatic at 14 days will receive a further clinical assessment and action taken as clinically appropriate.
Patients who do not show signs of deterioration within 14 days of the onset of symptoms will be discharged from the service. All patients are supplied with leaving information, self-care advice and information on how to safely return the pulse oximeter.
In Yorkshire and Humber, we have 16 schemes up and running covering the whole of the region and teams have worked hard to get these off the ground in a very short time. Patients are being actively enrolled and safely monitored.
If you missed the AHSN Network webinar on 9th Feb discussing ‘remote monitoring using pulse oximetry in care homes’ catch up with it here.
What is a COVID Virtual ward?
This model is aimed at patients recovering from COVID-19 in hospital beds who are improving and can be safely cared for in their own homes with support from an expert clinical team overseen by a senior doctor, or for patients coming to an emergency department where, although they don’t need admitting, the clinical team feel they need further monitoring at home. Before being sent home, these patients will be assessed as suitable, provided with a pulse oximeter and will have a clear plan in place with daily monitoring and escalation arrangements in case their condition deteriorates.
After 14 days of supported care, if the patients are well enough, they will be discharged from the scheme or if not, they may stay on the scheme for further care. They may also be referred on for help with long COVID symptoms.
Many of the hospitals in the region have experience of running similar virtual wards or early supported discharge schemes so there is a wealth of knowledge and skills in operating these safely.
|COVID Oximetry @ home||COVID Virtual Ward|
|WHERE||Primary Care Supervised||Hospital Supervised|
|WHO||Lower acuity/complexity||Higher acuity/complexity|
|WHEN||Community diagnosed patients||Emergency hospital patients|
|AIMS||Safe admission, avoidance and self escalation||Early supported hospital discharge, safe admission avoidance|
|HOW||Patient self monitoring/escalation. Earlier deterioration presentation||Monitored service. Reliable deterioration recognition.|
|WHAT||Supportive treatments||+/- Dexamethasone, LMWH, O2|
Why are these schemes important?
The early identification of deterioration in patients with symptomatic COVID-19 (clinically suspected or confirmed infection) who remain at home enables more timely clinical interventions and as such, has the potential to improve patient outcomes. Early experiences of implementing this approach have been linked to reduced mortality, hospital length of stay and the number of patients requiring intensive care admission and mechanical ventilation.
If we can identify COVID-19 patients with low oxygen levels early, there are proven treatments that improve the survival rates, but none of these treatments can be given early if we remain unaware of what patients’ oxygen saturations are.
The current pressure on hospital beds is immense: if we can safely send some patients home a little earlier this will reduce pressure on hospitals and help ensure we can provide excellent care for them. We know that being at home, when safe, is not only a better experience for patients but also can speed up recovery.
Evidence base: learning from the pilots
Eight large scale pilots were run nationally; there were different models tested with regional variation (preadmission models from primary care or ED ‘presenters’; stepdown models from secondary care admissions; or mixed approach models).
These pilots were evaluated and deemed successful, hence the new programme to spread similar models across England based on what we have learnt that works in practice.
Between March to August 2020, a sample of 2084 patients were measured, this showed that there was a 10 to 12.2% deterioration and escalation rate and 1% mortality rate. Overall patient experience was described as ‘positive’ & staff describe high levels of patient engagement.
- Rapid evaluation of remote home monitoring models during COVID-19 pandemic in England
- Validation of home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19
- Novel coronavirus (COVID-19) standard operating procedure: COVID virtual ward
What are we doing in Yorkshire and the Humber? (Role of PSC).
The Patient Safety Collaborative (PSC) supports the programme by providing engagement, coordination and support for implementation in the following ways:
- Engagement with regional and system partners, providing opportunities for sharing work and encouraging spread.
- Coordination of intelligence and learning, training in the model and transfer of learning. Help coordinate spread across Yorkshire and the Humber.
- Support for implementation through information, webinars (national and regional), developing networks supporting frontline colleagues delivering the interventions. Evaluating impacts of the work in collaboration with the national programme, evaluation work stream.
- Quality Improvement coaching.
National support available:
- NHS Futures: Repository of resources, implementation toolkit, virtual networking tool.
- Resources also available via the AHSN (if you don’t have an NHS e-mail)
- HSJ Training (series of short videos).
- Details of further advice, guidance and training materials including Academic Health Science Networks (AHSNs) and Patient Safety Collaborative contacts for bespoke support is available on the Future NHS Platform
For more information or to join our Yorkshire and Humber Learning network, contact: firstname.lastname@example.org
Take a look at the video below to find out more about Pulse Oximeters.