Aims/Objectives/Background The safe discharge of COVID-19 patients from the emergency department (ED) is difficult due to uncertainties surrounding the trajectory of the disease course. The infectivity of COVID-19 also limits follow-up options. A novel pathway consisting of home pulse oximetry with telephone follow-up was created to facilitate safe discharge from the ED of a London district general hospital. The primary objective was to utilise home pulse oximetry to prevent hospital admission. The secondary objective was to identify those requiring further care or investigation.
Methods/Design Adult patients with confirmed or suspected COVID-19 with oxygen saturations of between 90–94% who were otherwise suitable for discharge were identified. These patients were discharged from the ED with a pulse oximeter. Oxygen saturations were measured three times a day for seven days. Patients received a structured telephone consultation on days two, five and seven post-discharge from the ED, and a decision was made as to whether further clinical assessment in the ED was necessary.
Results/Conclusions Of the twenty patients discharged on the pathway, 85% avoided hospital admission, whilst 15% were re-assessed and subsequently admitted to hospital. 20% of patients required re-assessment in the ED but did not require admission.
Home pulse oximetry with telephone follow-up was used to prevent hospital admission in a considerable proportion of patients who would have otherwise been admitted in the absence of this pathway. Telephone follow-up effectively identified patients who required further clinical assessment. Increasing age, the presence of co-morbidities, and pulmonary infiltrates on chest radiograph were more common in the cohort who required re-assessment. This study demonstrates the potential for safe ambulation of a subgroup of patients with COVID-19, whilst identifying practical inclusion criteria which could be replicated in ambulatory units across the UK.
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