Over 52,000 people in the United States have now succumbed to coronavirus.
Tragically, many died at home because their local hospitals were stretched to capacity and they were turned away and told to monitor themselves for worsening symptoms. I've read stories where some patients returned to the hospitals again and again, only to be told, "You still aren't sick enough to be admitted, come back if you get worse."
What does "worse" mean for someone who's already been compelled to go to the hospital several times? Many people with COVID may not know they are getting worse; they feel fine yet their blood oxygen is dangerously low. The only way to identify this deterioration is to measure a patient's blood oxygen levels with a pulse oximeter. These devices are used in hospitals where patients are provided supplemental oxygen and sometimes respiratory support.
But patients typically sent home from the emergency department usually have no way to measure their oxygen levels. And even if they purchased a device online or through a drugstore, the patient is on their own to interpret the data and take action.
Fortunately, there is a solution, recently approved by the FDA, to monitor these patients in their homes and my team at University Hospitals in Cleveland has implemented it: the UH Remote Respiratory Monitoring System, powered by Masimo SafetyNet. This device is just as accurate as the devices used in hospital intensive care units and the information is monitored by trained clinicians. In anticipation of the COVID-19 surge, we were part of a pilot that deployed this new disposable technology for home monitoring. Patients who come to us with concerning COVID-19 symptoms, yet are deemed a low risk for clinical deterioration, are connected to this home-monitoring system.
The monitor looks like a piece of medical tape connected to a wrist band and provides data about oxygen levels, heart rate and breathing rate. The information is pushed to an app on the patient's cell phone and the app sends the data securely to a command center where physicians and nurses monitor the patient. When a patient triggers a low oxygen alarm, our clinicians call the patient to see how they are doing. The clinicians also call patients twice a day to ask about changes in symptoms. One clinician in the command center can monitor 50 to 80 patients. We can also place patients on home oxygen to support their minimal oxygen needs. And patients can give their loved ones access to the app so they, too, can help monitor the vitals. By measuring a patient's oxygen level, we can identify when patients' conditions are worsening and refer them back to the hospital. We can also comfort worried patients whose oxygen is at normal levels and reassure them they can safely stay home.
Home monitoring also provides other benefits. For patients who do not have COVID-19 but may have other health conditions such as COPD or congestive heart failure that require monitoring of oxygen levels they can safely stay home rather than risk infection from a trip to the hospital. And for the COVID-positive patients who can safely stay at home with this device, it reduces the potential infection of hospital staff and preserves personal protective equipment.
There's no place like home and, today, we have the technology to utilize the home as a virtual extension of a hospital room. This solution assures patients that trained medical professionals are looking after them and will tell them if, and when, it's appropriate to return to the hospital. This is not 1918. We don't have to turn people away to care for themselves. We have an extra century of medical innovation at our disposal, and we should use every tool available to safely manage COVID-19 patients who desperately need our help.
Peter J. Pronovost, MD, PhD, is the Chief Clinical Transformation Officer at University Hospitals in Cleveland, Ohio, and a Professor of Medicine at Case-Western Reserve University. He is a leading physician-scientist in the field of patient safety and critical care performance, and a former recipient of a MacArthur Foundation Fellowship.