The identification of coronavirus disease 2019 (COVID-19) patients with oxygen saturations between 90-94% who can be safely discharged from the emergency department (ED) is challenging due to the difficulty of community monitoring. A pathway consisting of home pulse oximetry with telephone follow-up was devised and implemented at a London District General Hospital to facilitate the safe discharge of these patients from the ED. Twenty patients with confirmed or suspected COVID-19 with oxygen saturations between 90%-94% were discharged on this novel ambulatory care pathway. Eighty-five percent of patients successfully avoided hospitalisation, whilst 15% were re-assessed and subsequently admitted to hospital. Home pulse oximetry monitoring was utilised to aid discharge from the ED and therefore prevent hospital admission. Telephone follow-up identified patients requiring further assessment. This study demonstrates the potential for safe ambulation of a subgroup of patients with COVID-19.

comorbidities. Hypertension was more common in the cohort of patients who required reassessment, which supports previous studies showing that cardiovascular comorbidities are associated with increased mortality in COVID-19. 2 Pulmonary infiltrates on chest X-ray were more common in the cohort of patients who required reassessment, mirroring the importance of radiological findings in the outcomes of COVID-19 patients. 3 ConclusionsHome pulse oximetry with telephone follow-up was used to prevent hospital admission in a considerable proportion of patients who would have otherwise been admitted in the absence of this pathway. Telephone follow-up effectively identified patients who required further clinical assessment.This study demonstrates the potential for safe ambulation of a subgroup of patients with COVID-19, while identifying practical inclusion criteria that could be replicated in ambulatory units across the UK. Future research should focus on the inclusion of various prognostic markers, due to their potential power in determining disease trajectory. n Conflicts of interestNone declared.

A re-audit was conducted 4 weeks after the new AMU opened, 88 patients were audited over a 1-week period. Following a grand round presentation and internal communications to the medical teams, there was significant reduction in the percentage of rejected referrals (18%), and onward referrals to other specialties (19%). Although the percentage of patients seen in AEC post discharge from medical ward had gone up to 32%; 75% of these patients were discharged from the acute medical wards, aiding in admission reduction and reduced length of stay. Unfortunately, there was an increase in the number of referrals to follow-up blood test results to 28%.