COVID-19 Oximetry @home
- NHS England guidance
- Tools and resources (including FutureNHS workspaces)
- Progress reports
- Key research
COVID virtual wards (secondary care)
- NHS England guidance
UCL Partners
Simulation videos designed to support trusts setting up Oximetry @home and Virtual Ward services.
A
simple device has been a lifeline during the pandemic – and could change how we
provide care for good. [NHS England blog, 22 March 2021]
Dr Matt Inada-Kim National Clinical Director for Infection,
Antimicrobial Resistance & Deterioration explains the impact of COVID
Oximetry @home and COVID
virtual ward services, and how the learning is now being incorporated into
the design of other care pathways.
Digital
home care for people with coronavirus [NHSX blog 22 March 2021]
NHSX Chief Digital Officer Tara Donnelly reflects on the
experience of patients with COVID-19 being cared for remotely using a
tech-enabled service.
NHS England Guidance
Pulse
oximetry and racial bias, NHS Race and health
Observatory 26 March 2021
A review has
highlighted issues around the accuracy of Pulse Oximeter readings from black
and minority ethnic people which could be seriously misleading, particularly
during the Covid-19 pandemic, and need further assessment.
- MHRA guidance on the use of pulse oximeters (26 March 2021) states “ The MHRA is not aware of any incidents where skin colour has had an adverse effect on the use of pulse oximeters when providing effective clinical care”
Pulse oximetry to detect early deterioration of patients with COVID-19 in primary and community care settings, NHS England 11 June 2020 updated 29 January 2021
Tools and resources
COVID Oximetry @home - digital and data services
NHS Digital are delivering digital and data services for COVID Oximetry @home, a service to monitor patients with coronavirus (COVID-19) symptoms in their own home or care home.
Covid Oximetry at Home Toolkit, Wessex AHSN
The Covid Oximetry at Home work (aka "virtual ward") describes an enhanced package of care for individuals with confirmed or suspected Covid-19 who are at risk for future deterioration.
NHS Digital are delivering digital and data services for COVID Oximetry @home, a service to monitor patients with coronavirus (COVID-19) symptoms in their own home or care home.
NHS England case study 28 January 2021
- Future NHS platform workspaces [registration required]
NHS @home provides an important opportunity to enhance NHS services, utilising the best technologies available to enable personalised clinical support to be delivered virtually to people in the setting of their own home including care homes. This workspace dedicated to NHS @home, aims to act as repository for useful information, documentation, contacts and links to other workspaces useful in developing and delivering @home services. Includes Link to COVID Oximetry @home
Covid -19 virtual ward toolkit FutureNHS National Deterioration Forum
A COVID-19 virtual ward toolkit is part of an evolving set of resources initially from the pilot sites and early adopters to share learning and support others wanting to implement Covid Virtual wards.
A COVID-19 virtual ward toolkit is part of an evolving set of resources initially from the pilot sites and early adopters to share learning and support others wanting to implement Covid Virtual wards.
A space on the FutureNHS collaboration platform is dedicated to accelerating the spread of evidenced digital innovations in health and care with a focus on empowering people with their data and supporting people at home. Includes Digitally-enabled COVID-19 Virtual Wards; Clinical Communication Tools; Telemedicine in care homes (Wessex AHSN link).
Progress reports/evaluation
COVID-19 patient safety response, National Patient Safety Improvement Programmes September 2021
An examination of the roll-out of COVID Oximetry @home and COVID virtual wards, both designed to allow vulnerable people’s care to be managed safely at home. The report highlights ten areas of learning from the process of setting up and spreading these programmes at pace, and practices that may be useful for the future delivery of rapid safer care initiatives.
Implementation Support For COVID Oximetry And Virtual Wards, KSS AHSN 11 November 2020
Key Research
medRxiv 2021.05.29.21257899; doi: https://doi.org/10.1101/2021.05.29.21257899
A retrospective
service evaluation of COVID-19 patients onboarded to CO@h from November 2020 to
March 2021 in the North Hampshire (UK) community led service (a collaboration
of 15 GP practices, (population = 230,000). CO@h patients has had significantly
reduced mortality rate and hospital length of stay. Only 5/137 (3.6%) where
admitted to ICU compared with 52/633 (8.2%) for Non-CO@h.
EClinicalMedicine, April 20201, v34, 100799. https://doi.org/10.1016/j.eclinm.2021.100799.
A multi-site mixed methods study conducted between July and August 2020 that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models developed during the first wave of the COVID-19 pandemic in England. The study combined interviews (n = 22) with staff delivering these models across eight sites in England with the collection and analysis of data on staffing models and resource allocation.
Remote management of covid-19 using home pulse oximetry and virtual ward support
BMJ 2021; 372 :n677 doi:10.1136/bmj.n677
Home oximetry requires clinical support, such as regular phone contact from a health professional in a virtual ward setting. More research is needed to understand the safety and effectiveness of home oximetry and to optimise service models and referral pathways
Pulse oximetry and racial bias
NHS Race and health Observatory 26 March 2021
BMJ 2021; 372 :n677 doi:10.1136/bmj.n677
Home oximetry requires clinical support, such as regular phone contact from a health professional in a virtual ward setting. More research is needed to understand the safety and effectiveness of home oximetry and to optimise service models and referral pathways
NHS Race and health Observatory 26 March 2021
A review has highlighted issues around the accuracy of Pulse Oximeter readings from black and minority ethnic people which could be seriously misleading, particularly during the Covid-19 pandemic, and need further assessment.
The implementation of remote home monitoring models during the COVID-19 pandemic in England
medRxiv 15 November 2020 [Preprint]
University of Southampton and Hampshire Hospitals Foundation Trust 2020
Nuffield Trust Rapid Service Evaluation Team 23rd October 2020
Rapid evaluation of remote home monitoring models during COVID-19 pandemic in England (12 October 2020) (Report from "A mixed methods evaluation of remote home monitoring models during the COVID-19 pandemic in the UK" - NIHR132703)
A mixed-methods evaluation of remote home monitoring models in the UK. Project overview and results of a rapid systematic review of the use of remote home monitoring during the COVID-19 pandemic.
Rapid evaluation of remote home monitoring models during COVID-19 pandemic in England (12 October 2020) (Report from "A mixed methods evaluation of remote home monitoring models during the COVID-19 pandemic in the UK" - NIHR132703)
For full review see Remote home monitoring (virtual wards) during the COVID-19 pandemic: a systematic review [Preprint 12 October 2020]
(Output from an ongoing research project by NIHR BRACE Rapid Evaluation Centre see: Remote home monitoring (virtual wards) during the COVID-19 pandemic)
BMJ 2020; 371:m4151 27 October 2020 doi: https://doi.org/10.1136/bmj.m4151
NHS England is believed to have purchased around 200 000 pulse oximeters to spot deterioration in patients with COVID-19, which CCGs across England will be able to access. The initiative is set to be rolled out across the country over the next six weeks and is being led by Matthew Inada-Kim, national clinical lead for deterioration at NHS England and a consultant in acute and general medicine at Hampshire Hospitals NHS Foundation Trust. The idea is to create “virtual covid wards” of patients at risk.
See also: Media release Remote Community Oximetry Care (RECOxCARE)
RCGP paper on Virtual Wards, Silent Hypoxia and improving COVID outcomes,
See also: Media release Remote Community Oximetry Care (RECOxCARE)
RCGP paper on Virtual Wards, Silent Hypoxia and improving COVID outcomes,
RCGP 18 October 2020
NHS England is currently piloting a virtual ward concept aimed at encouraging COVID-19 positive patients to monitor their own oxygen saturations using loaned oximeters and report it to a central monitoring service. Similarly, individual practices or health systems have been undertaking this for themselves to benefit patients. Patients are advised and supported as to when they should call for additional advice or seek urgent help based on their oximetry levels. This paper sets out the known evidence for this concept and the role of GPs in delivering and supporting this. Includes the include Tees Valley COVIDCare@HOME model and GP Level Home Oximetry solutions.
Age and Ageing, v49(6) November 2020, Pages 907–914, https://doi.org/10.1093/ageing/afaa191
A rapid review describes the satisfaction, clinic productivity, clinical benefit, and costs associated with the virtual geriatric clinic model of care. Analysis of 9 studies (n=975 patients) indicates that virtual geriatric clinics demonstrate evidence of productivity, benefit to patients, cost effectiveness and patient satisfaction with the treatment provided.
A rapid review describes the satisfaction, clinic productivity, clinical benefit, and costs associated with the virtual geriatric clinic model of care. Analysis of 9 studies (n=975 patients) indicates that virtual geriatric clinics demonstrate evidence of productivity, benefit to patients, cost effectiveness and patient satisfaction with the treatment provided.
COVID Virtual wards (Secondary care)
Covid Virtual Ward (secondary care), Wessex AHSN January 2021.
The Covid Virtual Ward model is a secondary care led initiative to support early and safe discharge (step down) for Covid patients and builds on the Covid Oximetry @home model. More information on the FutureNHS Collaboration Platform
The Covid Virtual Ward model is a secondary care led initiative to support early and safe discharge (step down) for Covid patients and builds on the Covid Oximetry @home model. More information on the FutureNHS Collaboration Platform
Remote
home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a
rapid systematic review
EClinicalMedicine
v37 (100965) July 2021
A rapid systematic
review on models led by primary and secondary care across seven countries (US,
Australia, Canada, The Netherlands, Ireland, China, UK) identified 27 articles.. The main outcomes
included in the review were: impact of remote home monitoring on virtual length
of stay, escalation, emergency department attendance/reattendance,
admission/readmission and mortality. Monitoring was carried via online platforms, paper-based systems with telephone
calls or (less frequently) through wearable sensors. No substantive conclusions
regarding patient safety and the identification of early deterioration due to
lack of standardized reporting and missing data.
NHS England guidance
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