Triage Into the Community for COVID-19 (TICC-19) Patients Pathway – Service evaluation of the virtual monitoring of patients with COVID pneumonia

Abstract

Introduction: COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand. Methods: We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a ‘Virtual Ward’ for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care ‘Hot Hub’. This allowed the safe and managed readmission of those patients who deteriorated at home. Results: During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month. Conclusion: It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.

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

“…13 studies with a combined total of 2908 participants were included in our systematic review ( table 1 ). 14 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 All participants had either confirmed or presumptive COVID-19, except for 12 healthy individuals who acted as a control group in one study by Motta and colleagues. 45 Another study by Gordon and colleagues 44 involved a control group of patients with COVID-19 who were not given pulse oximeters for remote monitoring.…”

“… 51 Some studies targeted only patients with mild and intermediate risks of deterioration, while recommending that the same model be tested among patients with more complex health needs to compare outcomes. 48 , 53 Ko and colleagues 49 also used an RPM model to monitor the SpO 2 of male migrant workers in Singapore in a specific, resource-limited setting, and the model was reported to be effective and safe.…”

“…One study 44 scored seven stars on the NOS tool, indicating good quality. Seven studies 14,45–50 scored five or six stars, indicating fair quality, whereas five studies 51 , 52 , 53 , 54 , 55 scored four or fewer stars. The absence of a control group in most of the studies negatively influenced the quality by scoring zero out of two stars in the comparability aspect of the NOS tool.…”

“…Patients were monitored for an unweighted average of 12·7 days, as reported in 11 of the 13 studies. 44 , 45 , 46 , 47 , 48 , 49 , 50 , 52 , 53 , 54 , 55 RPM models used pulse oximeters in addition to other monitoring tools, such as thermometers, a peak flow measuring tool, 45 a blood pressure cuff, 51 and symptom monitoring charts. All studies offered a 24/7 (ie, 24 h every day) emergency telephone line for their patients.…”

“…Participants in five studies received reminders by telephone call or through text message; however, the frequency of reminders varied. 44 , 46 , 49 , 53 , 54 For instance, reminders were set at once per day in three models, 44 , 53 , 54 twice per day in one model, 49 and were based on a predefined schedule in other models. 46 , 51 , 52 The rationale behind the frequency of reminders was not evident in most cases.…”