Patient-Reported Symptom Severity and Pulse Oximetry in the Covid-19 Remote Monitoring Programme in Ireland

Abstract

Rationale: A total of 60,287 (1,267/100,000) cases of Covid-19 (SARS-CoV-2) were recorded in Ireland by 30 October 2020. An important strategy to free up in-hospital capacity was development of a remote monitoring platform to support at-home care or early discharge of lower-risk patients with mild/moderate Covid-19 symptoms. Methods: The monitoring platform consisted of a patient-facing app + pulse oximeter (Bluetoothconnected Nonin 3230) enabling patients to record symptoms (e.g. breathlessness, diarrhea;severity rated on a 10-point scale), temperature & oxygen saturation (SpO2). Patients were prompted to record measurement 4 times/day. Patient-recorded data was viewed in real time by their healthcare centre via a dedicated web-based monitoring portal. Criteria for remote monitoring included: Covid-19 symptoms, positive for SARS-CoV-2, young age, absence of serious concomitant conditions, need for continued observation post-discharge. Treatment centres emailed app installation instructions and supplied a pulse oximeter to their patients. Treatment centres & patients received alerts if pulse oximetry values crossed pre-defined thresholds. Results: Between 13 March and 31 October 2020, 1,045 patients at 8 primary & 15 secondary care centres had used the remote monitoring platform [median duration: 13 days (interquartile range 10-23 days)]. 11 patients were admitted to hospital and 12 previously hospitalized patients were readmitted. 933 patients (89%) gave consent to use of their pseudonymised data for research. Symptoms and physiological markers of severity of infection varied considerably. 871 patients recorded breathlessness data with 53 rating severity as 6/10 and 23 as 8/10. 300 patients recorded diarrhea data with 24 rating severity as 6/10 and 6 as 8/10 (see Figure). SpO2 data were available for 907 patients. 733 patients reported SpO2 94-96%, 334 reported SpO2 92-93%and 265 patients reported SpO2 ≤91% at least once during the monitoring period. Conclusions: Remote monitoring of Covid-19 in appropriate patients can free up in-hospital capacity. The majority of these patients were willing to provide pseudonymised data to support research on Covid-19. .