When COVID-19 patients come to hospital with an advanced course of the disease, they often arrive in acute care emergency departments with very low oxygen saturations, often without accompanying breathlessness (‘silent hypoxia’). As a result, many patients have experienced extended hospital stays, invasive treatment, potential admission to Intensive Care Units (ICU) and death.
Remote home monitoring models (sometimes referred to as ‘virtual wards’) allow patients most at risk of deteriorating to monitor their vital signs at home and report readings to hospital or primary care staff. This helps avoid unnecessary hospital admissions (appropriate care at the appropriate place), and escalates cases of deterioration at an earlier stage to avoid invasive ventilation and ICU admission. Remote home monitoring models have been implemented in the US, Australia, Greece, Canada, and the UK, with some variation in the frequency of patient monitoring, technology used (telephone or video calls and use of applications or online portals), patient criteria and use of pulse oximetry.
Despite previous research on the use of remote home monitoring models for other conditions, there is a lack of research on the implementation of these models during the COVID-19 pandemic. This evaluation of remote home monitoring models in the UK seeks to address this gap in two phases: (i) by capturing the lessons learned during the implementation of these models in first wave of the pandemic and (ii) evaluating the use of these models during winter 2020-2021.
Phase 2 of the study, currently in progress, will evaluate the models implemented during wave 2 of the pandemic using a mixed-methods study design.
Titled COVID Oximetry @ home (CO@h), the project will address: clinical and cost-effectiveness; implementation; and patient and staff experiences of managing people with COVID or suspected COVID symptoms. The project will look at how oximeters have been used in the community to allow earlier discharge, as well as preventing hospitalisation. Patients can keep track of their own oxygen levels at home and only come into hospital if their reading drops below a determined number.
The study will comprise 4 workstreams: Clinical effectiveness, Cost effectiveness, Patient experience/behaviour change and Workforce experience/behaviour change in order to answer the following 4 questions:
1. How is CO@h associated with mortality and use of hospital services?
2. What are the costs of CO@h and is it good value for money?
3. What are the experiences and behaviours (i.e. engagement with CO@h, use of other services) of patients in CO@h? Do these vary by type of model or patient characteristics?
4. What are the experiences of staff delivering CO@h? What are the factors influencing delivery of CO@h? Do these vary by type of model, geography etc.?
- Slide deck: COVID Oximetry @home evaluation: Interpretation of findings
- Slide deck: Pulse oximetry in care homes during the COVID-19 pandemic: Interpretation of findings
- Preprint: The impact of remote home monitoring of people with COVID-19 using pulse oximetry: a national population and observational study.
- Preprint: Patients’ and carers’ experiences of, and engagement with remote home monitoring services for COVID-19 patients: a rapid mixed-methods study.
- Preprint: The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: a national observational study using hospital activity data.
- HSRUK 2021 Conference workshop session: Understanding the impact of COVID Oximetry @home programme among COVID-19 patients in England - watch here.
- HSRUK 2021 Conference workshop session: What can we learn from COVID-19 about how to fund, co-ordinate and deliver rapid service evaluation in health and care? Presented by Manbinder Sidhu from the BRACE team - watch here.
- Panel discussion at Leaders in Healthcare Conference 2021, 8-11 November, London (online and in-person) - watch here.