Evaluating the impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in patients with covid-19 assessed in Accident and Emergency departments in England: a retrospective matched cohort study

  1. T Beaney
  2. J Clarke
  3. A Alboksmaty
  4. K Flott
  5. A Fowler
  6. JR Benger
  7. P Aylin
  8. S Elkin
  9. A Darzi
  10. AL Neves
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Abstract

Objectives

To identify the impact of a national pulse oximetry remote monitoring programme for covid-19 (COVID Oximetry @home; CO@h) on health service use and mortality in patients attending Accident and Emergency (A&E) departments.

Design

Retrospective matched cohort study of patients enrolled onto the CO@h pathway from A&E.

Setting

National Health Service (NHS) A&E departments in England.

Participants

All patients with a positive covid-19 test from 1stOctober 2020 to 3rdMay 2021 who attended A&E from three days before to ten days after the date of the test. All patients who were admitted or died on the same or following day to the first A&E attendance within the time window were excluded.

Interventions

Participants enrolled onto CO@h were matched using demographic and clinical criteria to participants who were not enrolled.

Main outcome measures

Five outcome measures were examined within 28 days of first A&E attendance: i) death from any cause; ii) any subsequent A&E attendance; iii) any emergency hospital admission; iv) critical care admission; and v) length of stay.

Results

15,621 participants were included in the primary analysis, of whom 639 were enrolled onto CO@h and 14,982 were controls. Odds of death were 52% lower in those enrolled (95% CI: 7%-75% lower) compared to those not enrolled on CO@h. Odds of any A&E attendance or admission were 37% (95% CI: 16-63%) and 59% (95% CI: 16-63%) higher, respectively, in those enrolled. Of those admitted, those enrolled had 53% (95% CI: 7%-76%) lower odds of critical care admission. There was no significant impact on length of stay.

Conclusions

These findings indicate that for patients assessed in A&E, pulse oximetry remote monitoring may be a clinically effective and safe model for early detection of hypoxia and escalation, leading to increased subsequent A&E attendance and admissions, and reduced critical care requirement and mortality.

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