The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: A national observational study using hospital activity data

Theo Georghiou; Chris Sherlaw-Johnson; Efthalia Massou; Stephen Morris; Nadia E Crellin; Lauren Herlitz; Manbinder S Sidhu; Sonila M Tomini; Cecilia Vindrola-Padros; Holly Walton; Naomi J Fulop

doi:10.1016/j.eclinm.2022.101441

The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: A national observational study using hospital activity data

EClinicalMedicine. 2022 Jun:48:101441. doi: 10.1016/j.eclinm.2022.101441. Epub 2022 May 12.

Affiliations

¹ Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, United Kingdom.
² Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom.
³ Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, United Kingdom.
⁴ Health Services Management Centre, School of Social Policy, College of Social Sciences, University of Birmingham, 40 Edgbaston Park Rd, Birmingham B15 2RT, United Kingdom.
⁵ Department of Targeted Intervention, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, United Kingdom.

Abstract

Background: There was a national roll out of 'COVID Virtual Wards' (CVW) during England's second COVID-19 wave (Autumn 2020 - Spring 2021). These services used remote pulse oximetry monitoring for COVID-19 patients following discharge from hospital. A key aim was to enable rapid detection of patient deterioration. It was anticipated that the services would support early discharge, reducing pressure on beds. This study is an evaluation of the impact of the CVW services on hospital activity.

Methods: Using retrospective patient-level hospital admissions data, we built multivariate models to analyze the relationship between the implementation of CVW services and hospital activity outcomes: length of COVID-19 related stays and subsequent COVID-19 readmissions within 28 days. We used data from more than 98% of recorded COVID-19 hospital stays in England, where the patient was discharged alive between mid-August 2020 and late February 2021.

Findings: We found a longer length of stay for COVID-19 patients discharged from hospitals where a CVW was available, when compared to patients discharged from hospitals where there was no CVW (adjusted IRR 1·05, 95% CI 1·01 to 1·09). We found no evidence of a relationship between the availability of CVW and subsequent rates of readmission for COVID-19 (adjusted OR 0.97, 95% CI 0.91 to 1·03).

Interpretation: We found no evidence of early discharges or changes in readmissions associated with the roll out of COVID Virtual Wards across England. Our analysis made pragmatic use of national-scale hospital data, but it is possible that a lack of specific data (for example, on which patients were enrolled and on potentially important confounders) may have meant that true impacts, especially at a local level, were not ultimately discernible. It is important that future research is able to make use of better quality - preferably linked - data, from multiple sites.

Funding: This is independent research funded by the National Institute for Health Research, Health Services & Delivery Research program (RSET Project no. 16/138/17; BRACE Project no. 16/138/31) and NHSE&I. NJF is an NIHR Senior Investigator.

Keywords: COVID-19; Observational study; Pulse oximetry; Remote monitoring; Virtual wards.