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The COVID-19 pandemic has changed the way we practice medicine in many ways. And some positive things that will outlast this pandemic have also resulted. Many public health measures will be remembered when the next pandemic hits. And the strides made using mRNA technology will likely be utilized in approaching cancer and other diseases. Medical practices have also changed. The most obvious one is the emergence of telemedicine, which is likely to be here to stay even after the pandemic has ended (see our November 2020 What's New in the Patient Safety World column Telemedicine Here to Stay But Use It Safely). Another useful practice might be virtual medication history interviews and discharge education (see our April 7, 2020 Patient Safety Tip of the Week Patient Safety Tidbits for the COVID-19 Pandemic). And our January 2022 What's New in the Patient Safety World column Some COVID-19 Practices May Outlast the Pandemic noted 5 other hospital practices that are likely to outlive the pandemic (Gillespie 2021, Advisory Board 2021):
1. A centralized monitoring system
2. Daily meetings to pinpoint safety and quality concerns
3. Reducing the number of times workers enter patients' rooms
4. Guides for respiratory treatments to reduce the spread of disease
5. Safety precautions for visitors
Now, Peter Pronovost and colleagues (Pronovost 2022) have pointed out yet another unexpected patient safety benefit - remote patient monitoring. The authors make a good case that patient risk, rather than physical location, should dictate the degree of monitoring. They begin by noting that many patients with COVID-19 who deteriorated or died at home could have benefited from continuous pulse oximetry. Use of currently available technologies can be used to monitor patients at home and help avoid hospitalizations. And they note that some payment reforms already made by CMS have made at-home monitoring possible for acute as well as chronic conditions feasible.
They cite a cost-utility analysis of remote pulse-oximetry monitoring of patients with COVID-2019 (Padula 2021) which projected that remote monitoring could potentially be associated with 87% fewer hospitalizations, 77% fewer deaths, reduced per-patient costs of $11,472 over standard care, and gains of 0.013 quality-adjusted life-years.
Pronovost et al. state Pulse oximeters used in hospitals can now be deployed at home with patient data relayed to smartphones, secure cloud servers, and web-based dashboards where physicians and hospitals can monitor the patients status in near real time. They acknowledge that a separate team likely would need to be created to focus on remote monitoring. They go on to describe the barriers which must be overcome before health systems take greater advantage of this opportunity.
They envision a scenario where monitoring data would be sent by the patient or via a technology platform that automatically transfers data. Parameters for home monitoring could include blood pressure, heart rate, electrocardiogram, pulse oximeter, temperature, and others. The care team could include a nurse with physician oversight and data could be reviewed either in real time or intermittently, based on the patients risk for deterioration.
It's not just COVID-19 patients that could benefit from home monitoring. Reducing the need for acute care hospitalization is a goal for many other conditions. Having in place the technology, data management systems, and clinical teams envisioned by Pronovost and colleagues should be in the plans for every healthcare system. The time is right.
See also our other columns related to COVID-19:
Gillespie L. Hospital safety practices that will outlive the pandemic. Modern Healthcare 2021; December 14, 2021
Advisory Board. Covid-19 led to new hospital safety measures. These 5 will outlast the pandemic. Advisory Board 2021; December 15, 2021
Pronovost PJ, Cole MD, Hughes RM. Remote Patient Monitoring During COVID-19: An Unexpected Patient Safety Benefit. JAMA 2022; Published online February 25, 2022
Padula WV, Miano MA, Kelley MA, et al. A cost-utility analysis of remote pulse-oximetry monitoring of patients with COVID-2019. Value in Health. Published online October 22, 2021
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