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Digital health
Ambulatory monitoring of patients with COVID-19: initial experiences and next steps
  1. Stephen P Connolly1,2,
  2. Henriette Wa Katolo1,
  3. Colm Cronin1,
  4. Alison Dingle1,
  5. Maria Creed1,
  6. Colin Edwards3,
  7. Katherine M A O’Reilly1,2,
  8. Brendan O’Kelly1,
  9. John Shearer Lambert1,2,
  10. Eavan G Muldoon1,2,
  11. Gerard Sheehan1,
  12. Heather Coetzee1,
  13. Alan Sharp1,
  14. Suzanne Dempsey1,
  15. Eileen O’Connor1,
  16. Jeremy Farrell1,
  17. Aoife G Cotter1,2,
  18. Tara McGinty1,2
  1. 1 Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2 University College Dublin School of Medicine, Dublin, Ireland
  3. 3 PatientMpower Ltd, Dublin, Ireland
  1. Correspondence to Dr Stephen P Connolly, Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland; sconnolly91{at}gmail.com

https://doi.org/10.1136/bmjinnov-2021-000875

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    Summary box

    What are the new findings?

    • COVID-19 remote monitoring using oxygen saturation monitoring appears to be a safe and acceptable means of monitoring SARS-CoV-2-infected patients in the community for deterioration, reducing bed days spent in the hospital.

    • Such application requires a highly protocolised service with a dedicated team and judicious application of the model to an appropriate subset of patients.

    • In our cohort of 502 patients monitored remotely, 49 patients required repeat assessment in an acute hospital and 42 required admissions. Three patients required high dependency unit/intensive care unit admission and no patients died from COVID-19 complications.

    How might it impact on healthcare in the future?

    • A significant saving in bed days was observed by the service, with a potential net cost-benefit.

    • This model may therefore be applied in future COVID-19 surges where bed shortages arise.

    Introduction

    Since cases were first described in December 2019, SARS-CoV-2 has posed a distinct challenge to healthcare delivery, and Ireland has been no exception. Hospital bed numbers per capita in Ireland are at 2.9 per 1000 inhabitants, bed occupancy is the highest in the European Union,1 care is predominantly delivered in 4 to 6-bedded wards, and single-room isolation facilities are in short supply, risking being overwhelmed by high caseloads. Droplet spread within environments increasingly appears to travel further than the initially predicted 2 m2 3 and one Irish hospital has reported as many as 49% of their COVID-19 cases occurring via nosocomial transmission, and higher (32%) mortality in this group.4

    We therefore identified a need to manage patients safely at home to minimise spread to susceptible patients and staff. As SARS-CoV-2 infection’s natural history includes a rapid deterioration, characteristically in the second week of the illness in those who develop severe disease,5 6 the challenge of safely caring for such patients in the community was raised.

    Given that COVID-19 causes pneumonitis and impaired oxygenation, it is …

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    Footnotes

    • Twitter @ColinEdwards767

    • Contributors Each author made substantive contribution to the design of the service and study, the data collection, data analysis or manuscript authorship. Each was sent a copy of each iteration of the manuscript for approval and suggested edits. The study and service were designed and steered by TM, AGC, JSL, GS, AS, SD, KMAO’R, MC and HC. The intervention was run and operated by MC, EO'C and JF. Data collection was undertaken by SPC, CC and HWK. Data analysis was performed by SPC. Manuscript writing was completed by SPC, with input from B’OK and AD. CE is a member of the patientMpower scientific team who reviewed the manuscript. The remote monitoring programme was developed by patientMpower Ltd with advice from external clinical experts (C. O’Seaghdha, and R. Costello of Beaumont Hospital, and KMAO’R of the Mater Misericordiae University Hospital). The deployment of the remote monitoring programme free of charge to clinical care centres in Ireland was supported by the Health Service Executive HSE of Ireland.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests The only authors with conflicting interests are as follows: CE is an employee of pMp, the private company which devised the smartphone application used in the intervention. KMAO’R has provided expert consultation to pMp in the past.

    • Provenance and peer review Not commissioned; externally peer reviewed.