COVID Oximetry @home and COVID virtual wards

Detecting the early signs of deterioration in patients with confirmed or suspected COVID-19 is a significant challenge for health and social care teams. As patients at risk of poorer outcomes can be identified by reduced oxygen saturation levels, the ability to recognise early decreases in blood oxygen levels before the patient becomes symptomatic is vital.

The national COVID Oximetry @home and virtual wards project won the Patient Safety Award at the 18 November 2021 HSJ Awards. The programme was delivered in partnership with NHS England and NHS Improvement, NHS Digital and NHSX, and helped over 40,000 people most at risk from COVID-19 to be safely supported at home, through remote self-monitoring of their oxygen saturation levels.

Below you will find key information about ‘COVID Oximetry @home’ and ‘COVID virtual wards’, including links to relevant resources and webinars.

What’s the difference between ‘COVID Oximetry @ home’ and ‘COVID virtual wards’?

The West of England Patient Safety Collaborative is supporting the use of pulse oximeters in our local health and care systems, both as part of the national COVID Oximetry @home and virtual ward models:

• COVID Oximetry @home uses pulse oximeters for patients at risk to safely self-monitor their condition at home, providing an opportunity to detect a decline in their condition that might require hospital review and admission. Early experiences of implementing this approach have been linked to reduced mortality, hospital length of stay, and the number of patients requiring intensive care admission and ventilation. Click here to view our COVID Oximetry @home implementation pack and watch our series of webinars.
• The COVID virtual ward model is a secondary-care-led initiative to support early and safe discharge from hospital (step down care) for COVID patients. It has already been implemented in some parts of the country where it is having an impact in reducing emergency admission and builds on the COVID Oximetry @home model. In January 2022 systems received a letter (C1041-letter-supporting-hospital-discharge-covid-virtual-wards-13-jan-21.pdf) recommending that all integrated care systems (ICSs) immediately establish COVID virtual wards to support the earlier and safe discharge of COVID-19 inpatients in addition to their work on COVID Oximetry @home pathways. Read more about COVID Virtual Wards and access our learning resources, including webinars.

What does this mean for patients?

General advice for anyone experiencing the symptoms of COVID-19 is available on the NHS website. The NHS has also published a ‘safety netting’ leaflet for people with suspected coronavirus who are isolating at home.

Patients may use a remote monitoring COVID-19 diary to track their pulse oximeter readings. Translations of the COVID-19 diary are available here as well as an using a pulse oximeter to check you are OK easy read version.

Health Education England has produced a short animation which explains how to use pulse oximeters at home and keep a COVID-19 diary:

Is there national guidance available? Where is the evidence?

Pulse oximetry and remote monitoring guidance has been published by NHS England and NHS Improvement along with standard operating procedures for COVID Oximetry @home and COVID virtual wards.

Read the operating procedures for COVID Oximetry @home here
Read the operating procedures for COVID virtual wards here

• This case study from Salford Royal NHS Foundation Trust describes their rapid deployment of a COVID-19 virtual ward to improve patient experience, flow and the interface to Same Day Emergency Care.
• This paper on Virtual Wards, Silent Hypoxia and improving COVID outcomes was published by the Royal College of General Practitioners in October 2020.
• This paper on the Validation of home oxygen saturations as a marker of clinical deterioration in patients with suspected COVID-19 considers whether the early identification of deterioration in suspected COVID-19 patients managed at home enables a more timely clinical intervention.
• HSJ has published this set of resources on pulse oximetry as a COVID early warning system.
• The HSJ have produced a suite of short training/information videos. These explain the background information for COVID Oximetry @home models based on first wave pilots highlighting Oxygen levels as a key indicator for deterioration in COVID-19, and why patients need to be monitored for silent hypoxia. The videos describe to GPs, Nurses, Paramedics and Care home staff how this can be done across the system to safeguard patients at home in COVID Oximetry @home virtual wards. Watch the HSJ training videos here.
• NIHR Applied Research Collaboration (ARC) Wessex and partners have compiled a report: An Evidence-Based Approach to Quality Improvement for COVID Oximetry @home. Read the NIHR report here.
• Dr Matt Inada-Kim is one of the authors of a pre-print publication examining home saturation in COVID confirmed cases as a trigger for initial hospital assessment. Read the pre-print publication here. The early identification of deterioration in suspected COVID-19 patients managed at home enables a more timely clinical intervention, which is likely to translate into improved outcomes. The authors undertook an analysis of COVID-19 patients conveyed by ambulance to hospital to investigate how oxygen saturation and measurements of other vital signs correlate to patient outcomes, to ascertain if clinical deterioration can be predicted with simple community physiological monitoring.
• Cecilia Vindrola-Padros, Naomi Fulop and Trish Greenhalgh describe the importance of oximeters and how they could save lives in Nuffield Trust article: ‘Virtual wards: caring for Covid-19 patients at home could save lives’. Read the Nuffield Trust article here.