COVID-19 has put significant pressure on the NHS. To address these challenges, it was important for the NHS to prioritise measures that help to avoid admitting patients to hospital where safe to do so, and providing early supported discharge from hospitals, helping to keep emergency care available for those that need it most.
It was noticed during the first wave of COVID that some patients were experiencing a drop in blood oxygen levels before developing any obvious symptoms. Therefore, the ability to recognise early decreases in blood oxygen levels was vital. Waiting until a patient with low blood oxygen levels has symptoms before they are admitted to hospital puts them at a significantly higher risk of needing to be admitted into intensive care. Conversely, patients whose blood oxygen levels remain stable, with no other symptoms, can be safely monitored at home and avoid hospital admittance.
For those patients who has been admitted to hospital, it was important to find a way to identify those at low risk and therefore suitable to be discharged early, with remote monitoring, freeing up capacity.
What we did
Pulse oximetry monitoring at home, as part of a package of care, was recommended by the World Health Organisation. Through our role as a Patient Safety Collaborative, we supported the use of pulse oximeters in our local region, focussing on the roll out of two care pathways – one for primary and one for secondary care.
The primary care model – COVID Oximetry @home – provided pulse oximeters for patients at risk so they could safely self-monitor their oxygen saturation levels at home, providing an opportunity to detect a decline in their condition that might require hospital review and admission.
The secondary care model – The COVID virtual ward – supports early and safe discharge from hospital (step down care) for COVID patients who may require hospital follow up but can be safely cared for at home.
“The virtual ward work is profoundly important both now and for future models of careDominic Dodd, Chair, Royal Free London NHS Foundation Trust
We supported the spread of these new models of care by facilitating conversations, curating, and sharing best practice and resources, aligning pathways across systems, and contributing to strategic plans to ensure long term sustainability. In January 2021, we collaborated with colleagues from Health Innovation Network, Imperial College Health Partners and NHS England and run two pan-London webinars which showcased examples of innovative ways of assessing and managing patients with suspected COVID-19 in the community.
We provided a supportive role to our four Integrated Care Systems (ICS’), supporting them with delivering locally focused on-boarding webinars that shared learning and further responded to local challenges, helping to drive collaboration within and across regions.
Through a National Learning Network, we enabled our partners to gain access to expertise from across the country. We also established a repository for locally developed resources across London and contributed to a national discussion forum to ensure rapid sharing of key information and learning. Resources produced have included Stop: Start simulation videos we created to support colleagues working in COVID Oximetry @home and COVID virtual ward services.
Through the wider AHSN Network we have been able to feedback on safety issues and other informal intelligence gathered from the front-line teams.
Acceleration of the spread of these models of care was enabled not only by providing bespoke support to frontline teams but also through our strong collaborative working with regional NHS teams and NHS X.
Impact and next steps
Tens of thousands of pulse oximeters have been distributed across England to enable patients to safely self-monitor their condition at home, ensuring that a decline in their condition is detected and escalated in timely fashion. Early results of implementing this approach have been linked to reductions in mortality, hospital length of stay and pressure on intensive care/critical care beds.
Every patient that I put on the CO@H liked it. I didn’t have one negative response. For the majority of my patients, they liked it because it gave them support and reassurance whilst being able to remain at home.
One of my patient’s lives was saved by it. She is a brittle asthmatic in her 60s who is very anti-hospital. I know she would not have gone in hospital were it not for the fact that we identified that her sats were 86%Sarah Armstrong, GP
As of mid-February 2021, 100% of CCGs and acute trusts in the UCLPartners region was providing Covid Oximetry @Home and COVID virtual ward services, respectively. Over 2000 patients have been supported across the COVID Oximetry @home service and over 250 patients on the step-down service (COVID Virtual Ward) thus far.
Moving forward it will be important to clearly demonstrate the benefits of these new models of care, ensure their sustainability and use them as a springboard for setting up virtual wards for other medical conditions and more personalised care in the community.
A national evaluation of this work is being led by UCL. We will be contributing learning from the UCLPartners region for this evaluation, in efforts to drive digital transformation, and encourage continuation of newly developed behaviours that have led to the success of the programme.