Innovation and adaption have been key with dealing with the current COVID crisis. Innovation and adaption have been key with dealing with the current COVID crisis.
In a quick thinking move staff in the Emergency Department at the Royal Melbourne Hospital (RMH) have created a platform to monitor patients for COVID symptoms outside of the hospital.
The program was set up to assist with anticipated pandemic numbers of COVID patients expected at the RMH. The idea was to use pulse oximeters, a small device that typically clips on to your finger, toe, or earlobe to measure oxygen levels in the blood. Using this device staff at the RMH could effectively monitor patients from their homes, allowing for a reduction in people using beds while still maintaining peace of mind.
The program was designed be able to safely send patients who do not currently require hospital treatment back home to self-quarantine, whilst still being able to rapidly identify a subset of patients who subsequently become significantly unwell and need to return to hospital.
RMH staff have created a novel software solution which assists patients to manage their own health, by monitoring their oxygen levels at home, and reporting back into the hospital using their own smartphone twice a day.
Every few hours the patient is asked to record vital signs and record the data, which is fed back into the hospital system. If there is a reason for concern the software will trigger a Met Call- a process which notifies the supervising clinician of a potential deterioration in the patient.
A pulse oximeter is a small electronic device that estimates the saturation of oxygen in your blood. According to the World Health Organisation, a healthy person should have a reading between 95%-100%. If the number drop below 92% this is reason for concern.
Emergency Department consultant, Dr Martin Dutch developed the program which has capacity to monitor 1000 patients.
“This is a cheap and effective way of monitoring patients and giving them peace of mind, knowing the hospital is keeping an eye on them when they aren’t physically on-site,” Dr Dutch said.
In the treatment of COVID-19 it’s become more apparent that patient’s symptoms often become worse during the second week of the illness. Monitoring from home means staff will be alerted immediately if there is any change to vital signs and importantly oxygen levels.
“COVID-19 provides some unique challenges for the health system. It is now clear that a subset of patients may have a very significant deterioration in their health in their second week of illness.
“This deterioration can often begin to occur silently, without a significant worsening of symptoms. A number of international centres are now recommending the early identification of this subgroup of patients, through use of pulse oximeters in the community,” Dr Dutch said.
However many health systems do not have processes setup to remotely manage large numbers of at risk individuals in the community.
The program uses a novel adaptation of REDCap™, a commonly used piece of hospital software, found in over 300 health institutions in Australia, and over 4,000 internationally. By linking this software to an SMS service, the Royal Melbourne Staff have developed a comprehensive system to reach out to patients in the community via text message, and allow them to reply with the oxygen level measurements and other important health information.
This system has been built with pandemics in mind, and is designed to handle large numbers of patients, with integration of automated advice to patients on their self-care, and the promotion of important public health messages.
Dr Dutch said “The costs of setting up a system are particularly affordable. The underpinning software is free to use for all health institutions, and our adaption can be downloaded for free.”