COVID Oximetry @home: evaluation of patient outcomes

Boniface, M.; Burns, D.; Duckworth, C.; Duruiheoma, F.; Armitage, H.; Ratcliffe, N.; Duffy, J.; O'Keeffe, C.; Inada-Kim, M.

Background: COVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID Oximetry @home (CO@h) was launched in November 2020 to support remote monitoring of COVID-19 patients in the community. Remote monitoring through CO@h aims to identify early patient deterioration and provide timely escalation for cases of silent hypoxia, while reducing the burden on secondary care. Methods: We conducted 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, covering a population of 230,000 people). We have compared outcomes for patients admitted to Basingstoke & North Hampshire Hospital who were CO@h patients (COVID-19 patients with monitoring of SpO2 (n=137)), with non CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Odds Ratio analysis was performed to contrast the likelihood of patient outcomes resulting in 30 day mortality, ICU admission and length of stay greater than 3, 7, 14, and 28 days. Results: Hospital length of stay was reduced by an average of 6.3 days for CO@h patients (6.9 95% CI [5.6 - 8.1]) in comparison to Non-CO@h (13.2 95% CI [12.2 - 14.1]). The most significant odds ratio effect was on mortality (0.23 95%CI [0.11 - 0.49]), followed by length of stay > 14 days (OR 0.23 95%CI [0.13 - 0.42]), length of stay > 28 days (OR 0.23 95%CI [0.08 - 0.65]), length of stay > 7 days (OR 0.35 95%CI [0.24 - 0.52]), and length of stay > 3 days (OR 0.52 95%CI [0.35 - 0.78]). Mortality and length of stay outcomes were statistically significant. Only 5/137 (3.6%) where admitted to ICU compared with 52/633 (8.2%) for Non-CO@h. Conclusions: CO@h has demonstrated considerably improved patient outcomes reducing the odds of longer length hospital stays and mortality.