A Virtual Care Model Utilizing Patient Directed Oximetry Monitoring for Outpatients with COVID-19: A Quality Improvement Study

Abstract

Background: There is a care gap for outpatients with COVID-19, with many lacking access to standardized medical care. We combined virtual clinical assessment with patient-directed oximetry to enhance clinical care of these patients. The aim of this study was to assess the role of oximetry and clinical outcomes of those enrolled in this novel clinical initiative. Methods: A team of General Internal Medicine, Infectious Diseases, and Respirology physicians in London, Ontario, partnered with the local public health unit (Middlesex London Health Unit) to enroll outpatients diagnosed with COVID-19. We assessed patients virtually and arranged for the same day delivery of an oximetry device to the patient's home in order to assess for hypoxemia. In this quality improvement study, we present our initial experience with the use of oximeters in virtual care and 30-day patient outcomes utilizing this novel clinical model. Results: Between April 23-May 19th, 2020, we assessed and monitored 51 patients in the community with COVID-19. Of these, 47% had an oximeter delivered to their residence. A majority of patients (91%) who experienced severe dyspnea had normal oxygen saturations. Our clinical intervention resulted in 3 direct admissions to a designated COVID-19 unit at a local hospital for decompensating patients. No deaths were noted. We have characterized a number of significant outcomes that warrant further medical and allied health follow up. Interpretation: We present a clinical model that supports the care and symptomatic management of patients in the community with COVID-19. Oximetry was found to primarily exclude the presence of hypoxemia in dyspneic patients, while identifying few patients with true hypoxemia. .