Covid remote monitoring

Covid Remote Monitoring

Delays in escalating patients’ care to hospital in the COVID-19 pandemic have resulted in patients being admitted to hospital with advanced COVID-19, thus requiring invasive treatment and potential admission to intensive care.

Remote home monitoring may help to reduce delays and identify at risk patients earlier.

Remote monitoring involves patient triage, providing patients with monitoring equipment, asking the patients to record their observations, monitoring calls from staff and follow-up once patients have been discharged from the service.

In November 2020, NHS England launched a national roll-out of this model of care called COVID Oximetry @ home.

In addition, in January 2021, NHS England launched a national roll out of early discharge models, referred to as ‘virtual wards’.

Covid@Home

What is Covid@Home/what is involved?

The use of oximetry to monitor and identify ‘silent hypoxia’ and rapid patient deterioration at home is recommended for patients most at risk of poor outcomes, who are best identified by oxygen levels.

Who Leads This Service?

This service is primary care (GP Practice) led.

Where is the service provided?

Within a patient’s home, nursing/care home and at Covid Hot Hubs.

When and where is this service available?

Service available 7 days a week 08:00 – 20:00 across NWL.

Service Features:

With Covid@Home in Covid Hot Hubs the patient receives:

  • A pulse oximeter and diary (paper or the HUMA app) to enable them to self-monitor 3 x a day
  • Regular telephone calls and face to face or home visits dependent on clinical need.

The patient is monitored for up to 14 days depending on clinical need

Existing evidence suggests the cohorts that will benefit most are those with:

symp.png

For further information on using this service please refer to the Standard Operating Procedure

Covid Virtual Wards

What is a Covid Virtual Ward/what is involved?

Covid virtual wards aim to provide early and supported hospital discharge for patients with a primary diagnosis of COVID-19 who are referred from ED or have an improving clinical trajectory (symptoms, function, oxygen saturation) and have no fever for 24-48 hours consecutively (without medication to reduce fever).

Who Leads This Service?

Secondary Care - led by named Consultant or ST3+ with COVID experience. 

Where is the service provided?

Within a patient’s home and acute trust

When and where is this service available?

Service available 7 days a week 08:00 – 20:00

May be integrated with 111/999 call handlers.

Service Features:

Patient receives

  • Proactive daily calls (virtual ward round).
  • A pulse oximeter and diary (paper or the HUMA app) to enable them to self-monitor 3 x a day
  • Phone support line available during service hours (via a Healthcare support worker).
  • Medication provided: e.g. O2.

 The patient is monitored for up to 14 days depending on clinical need

Cohorts that will benefit most from this service include

 

A diagnosis of COVID-19: either clinically or positive test result and being treated in secondary care services

X

Patients with saturations greater than 93% low NEWS2 (< 3) and no desaturation or risks may be discharged to a Covid Virtual Ward where clinically appropriate (agreed by Senior Decision Maker)

X Patients with saturations greater than 93% with improving clinical trajectories (symptoms, signs, blood results, CXRs), function can also be considered for Covid Virtual Ward

 

Patients with oxygen saturations of 92% or lower or experiencing moderate/severe shortness of breath are generally unsuitable for early supported discharge, unless the patient is stable, and this is their usual baseline saturation.

Clinical judgement remains paramount for all assessments particularly for COVID patients with higher risk factors or other complicating medical conditions.

*Subject to completion of a satisfactory exercise test.

 

For further information on using this service please refer to the attached Standard Operating Procedure

Covid Crisis Rescue Foundation/The Bike Shed

To support the management of patients in community settings, each Hot Hub or GP Practice will receive a supply of pulse oximeters.  These oximeters may be provided to those patients that are seen face to face on site.  For patients managed remotely who would benefit from a pulse oximeter, Covid Crisis Rescue Foundation, in conjunction with The Bike Shed couriers, has been commissioned to deliver pulse oximeters to patients’ homes.

Delivery of oximeters are made within the following timeframes:

  • Urgent requests — delivery within 90 minutes of request
  • Routine requests — delivery same day (maximum within 24 hours)

Referrals for urgent requests end at 6 pm and referrals for probes after 6 pm will take place the next morning

Please contact the provider on 01938820788 to arrange delivery of a pulse oximeter to a patient’s home.

For further information on using this service please refer to the attached Standard Operating Procedure

COVID Oximetry @ home evaluation

The COVID Oximetry @ Home study is evaluating the implementation and effectiveness of remote home monitoring models for patients with COVID-19 (also known as ‘virtual wards’). The study looks at range of different models of care, including pre-hospital and post-hospital early discharge models.

The evaluation is led by Professor Naomi Fulop and is a collaboration between researchers from NIHR RSET (University College London and Nuffield Trust) and NIHR BRACE (University of Birmingham and RAND Europe). This project was funded by NIHR HS&DR (RSET project no. 16/138/17; BRACE project no. 16/138/31) and has been designated as Urgent Public Health research by NIHR.

Why is this study important?

Delays in escalating patients’ care have resulted in some patients being admitted to hospital with advanced COVID-19, thus requiring invasive treatment and potential admission to intensive care. Remote home monitoring may help to reduce delays and identify at risk COVID-19 patients earlier. There are different ways of being referred to COVID care at home services, including through community referrals, referral through attending an emergency department and early discharge after being an inpatient in hospital.

In November 2020, NHS England launched a national roll-out of a remote home monitoring model called COVID Oximetry @ home. In addition, in January 2021, NHS England launched a national roll out of early discharge models, referred to as ‘virtual wards’. While there is evidence supporting the success of these models for other conditions, there is a lack of research on their effectiveness, implementation and patient experience for COVID-19.

What do we aim to do?

The research aims to evaluate COVID care at home models by examining:

•          Effectiveness;

•          Cost-effectiveness;

•          How models have been implemented in different sites and the enablers and barriers to implementation; and

•          Patient and staff experiences of engagement and delivery.

Figure 1. A summary of the four evaluation workstreams

evaluation work stream.png

 

Figure 1 describes the processes for each work stream. Most of our evaluation will be undertaken as a service evaluation; however, the patient experience elements in workstream 3 and 4 (national survey and in-depth case study interviews) will be badged as “research” (as per our Health Research Authority ethics submission). Please note:  All sites will participate in national survey of staff and patients, and a sub-set of sites have been selected as case studies in which interviews will be undertaken with staff and patients.

When will the evaluation take place?

The evaluation will take place between November 2020 and June 2021. Data collection will take place between February and April 2021.

We will share interim findings throughout the project and will submit the final report in June 2021.  

Ethics and Research Governance

The evaluation is divided into two protocols which have both received ethical approval from relevant authorities:

  1. Workstreams 1, 2 and the staff survey and interviews for workstreams 3 and 4 are part of a service evaluation and have received ethical approval by the University of Birmingham Humanities and Social Sciences ethics committee and the UCL/UCLH Joint Research Office.
  2. The patient survey and interviews for workstreams 3 and 4 have been designated Urgent Public Health Research by NIHR. This element of the evaluation has received ethical approval from the HRA. 

Webinars

NWL COVID@HOME Webinar: Identifying High-Risk Patients using S1/ EMIS/ WSIC

The NWL webinar, held on 20th January2021, on identifying high-risk patients in the context of Covid@Home can be accessed via:

https://www.youtube.com/watch?v=RBa83LLwLR0

 

NWL COVID@HOME Webinar: Covid@Home and Covid Virtual Wards

The NWL webinar, held on 4th February 2021, on Covid@Home and Covid Virtual Wards can be accessed via:

https://vimeo.com/510627905 (Password = NHS)

Resources and Standard Operating Procedures

Useful Resources

Standard Operating Procedure: Oximetry in Primary Care

This Standard Operating Procedure (SOP) covers the process for the management of Covid Oximetry@home in general practice.

 

Standard Operating Procedure: NWL- Covid-19 Escalated Care Clinic

This Standard Operating Procedure (SOP) covers the process for the management of Covid Oximetry@home in Escalated Care Clinics.

 

Summary of Covid@Home and Covid Virtual Ward Pathways

This document focuses on Covid@Home and Covid Virtual Ward and aims to

provide a summary of the services, how they interrelate and how they differ.

 

Patient Information Leaflet: Suspected coronavirus (COVID-19)- Important information to keep you safe while isolating at home

This leaflet is for patients with suspected coronavirus who have not been admitted to hospital and will be isolating at home.

 

Oximetry@Home Templates On EMIS and SystmOne

This document provides a screen-shot/summary of the Oximetry@Home Templates On EMIS and SystmOne, which is designed to assit GPs in NWL to identify those patients at risk of deterioration from Covid-19 and enable early on-boarding into a Covid19 Oximetry@home service.

 

SOP: Escalation Care Clinics – Extracting and Submitting Data

This document provides an overview of Extracting and Submitting Data from Escalated Care Clinics using SystmOne.