People with COVID-19 are at risk of relatively sudden deterioration in the first two weeks of the illness. Telescot are working with Scottish Government Technology Enabled Care (TEC) to develop a telemonitoring system for following up people with COVID-19 at risk of deterioration using pulse-oximetry.
The key principle is that telemonitoring has to be simple enough that it maximises the proportion of people at risk who can use it, and can be deployed with minimal training given the risks of prolonging face-to-face contact.
Suspected COVID patients attending an assessment centre, who are to be discharged home will be enrolled in the telemonitoring system, given a pack with equipment and information on its use. Either later that day or the following day they will receive a call from the monitoring service to explain the system and resolve any queries.
Patients are given a written self-management plan and advised that telemonitoring is just an aid and that any significant symptom or oximetry deterioration at any time should prompt an immediate contact for advice, rather than waiting for the next routine request for data.
At least once daily, records of active patients will be scanned to ensure data is being sent and that appropriate action has been taken by the patient. At the end of a fortnight, patients will be asked to return the equipment.
Choosing which data to collect
A daily symptom diary will be collected, covering:
- change in breathlessness from the day before
- current severity of breathlessness
- any other potentially relevant symptoms
Patients will be asked to record:
- their temperature
- pulse oximetry readings twice daily, at both rest (after 20 minutes seated) and after walking on the flat for one minute
Device and data transmission
The Scottish system to be initially implemented will use commercially available pulse oximeters and thermometers. It is based on an SMS based text service (Florence) which will work with any mobile phone and which is configured for secure data delivery to NHS systems. However, there are plans to move to a system which also incorporates digital web-based communication.
Patients will be texted reminders to complete symptom diaries and temperature/pulse oximetry, and text data back to a central server which collates a report for the clinical team.
Patients whose symptoms or pulse oximetry suggest deterioration (for example, significantly increased breathlessness or SpO2 <94% in a previously well person) are automatically asked to contact the local COVID community hub for reassessment.
The patient data will be available for clinicians in graphical or tabular format. There are plans to explore the value of more integrated smartphone-based systems later.
Evaluation and optimisation
It is unclear which patterns of symptoms or SpO2 levels are the best markers of early deterioration, so initial alert levels are based on clinical judgement and extrapolation from other conditions.
Linkage of telemonitoring data to outcomes (reassessment, admission to hospital, need for respiratory support or ICU, death) will allow tailoring of alert thresholds to the condition.
|Funder||Scottish Government TEC fund|
|Chief Investigator||Professor Brian McKinstry|