By Cecilia Nasmith
Northumberland Hills Hospital announces a proactive remote-monitoring process for COVID-positive patients being undertaken with Northumberland Paramedics and Home and Community Care Support Services Central East to extend support beyond the hospital walls to monitor and assist these patients in the community – and enhance the sharing of information in the event their condition worsens and hospitalization becomes necessary.
Dr. Mukesh Bhargava led the way with a small Community Escalation Team of local family physicians (Drs. Mark Essak, Erin Pepper and Fraser Cameron). The process also relies on the support of a team of Home and Community Support nurses, NHH Infection and Prevention Control and the NHH COVID-19 Assessment Centre.
Thanks to this collaboration, all COVID-positive patients diagnosed in the hospital's Assessment Centre of Emergency Department but deemed well enough to be discharged home are now invited to consent to participate in this voluntary remote-monitoring program. Direct referrals are also accepted from area primary-care physicians whose patients may have had a COVID-positive diagnoses outside the community, and individuals who reside in a home with a referred patient may also opt to self-refer for monitoring as well.
Upon consent, these referrals are sent to Home and Community Care Support Services for intake and set-up of internet-enabled oxygen monitoring and remote surveillance. The tools work in tandem with a smart phone or tablet as well, so individuals who cannot enable virtual monitoring can have telephone-based monitoring set up.
It's simple for patients to use and simple for Home and Community Care Services nurses to administer, Clinical Care Programs Senior Manager Cathy Slevin said in the announcement.
“The process NHH has set up to auto-refer patients diagnosed with COVID is very smooth,” Slevin commented.
“It allows us to reach out as soon as a patient is identified and get the remote monitoring quickly in place. Essentially, an app is installed through a link we send the patient via e-mail or text. This app triggers an automated prompt twice a day, requiring the patient to answer five or six questions. Are you experiencing shortness of breath? Has your cough worsened? Is your temperature elevated?
“The questions typically take no more than five minutes for the patient to complete and submit. The Home and Community Care nurse receives the responses in real time, reviews and – if any concerns, such as oxygen levels lower than the acceptable norm – reaches out. The nurse can text the patient directly through the app, or call the patient by phone.”
This system serves as a community-based early-warning system in the event a patient deteriorates swiftly, while the intake and tracking establish a point of contact to support a smooth hand-off (through the Home and Community Care nurse) to the NHH Escalation Team or Emergency Department should the patient's condition require urgent hospital re-assessment or admission.
Northumberland's Community Paramedicine program is another resource that can be drawn on, should urgent support be required in the patient's home – though, to date, this has not been required.
“We saw a need for a proactive solution and pulled a team together to action it quickly,” Dr. Bhargava – NHH Chief of Staff and a member of the Internal Medicine team actively involved in delivering in-patient care to COVID-positive patients.
It's a straightforward process, he stated.
“Many patients do not require hospitalization, particularly in the early stages following diagnosis, but we were seeing some destabilize quickly and return to the Emergency Department with dangerously low oxygen levels.
“Just as important, we were seeing patients who were quite anxious and fearful of whether or not they would know if their symptoms were severe enough to reach out for help.
“The aim of this program is to avert sudden destabilization while, at the same time, offering reassurance to the patient, and their loved ones, that clinical oversight is never far away.
“What I personally find most reassuring is that, from a community perspective, we have an additional safety net built through proactive collaboration to further minimize the risk of a COVID-positive resident falling through the cracks because they simply did not know when to seek care.”
It's an approach that is proving to be effective. The patient name and contact information flows from NHH, on the patient's consent, and a member of the Home and Community Support Services team reaches out within 24 hours to co-ordinate the delivery of an oxygen-saturation monitor. To date, 44 patients have been monitored remotely with a 100% consent rate for participation – most using the app and several using a land-line telephone.
Dr. Cameron said the vast majority of patients who contract COVID will get better.
“In some situations, though, symptoms get worse, even among younger, healthier patients, and it can happen swiftly.
“Success of this program is measured in the absence of patients going to the NHH Emergency Department in crisis after being diagnosed with COVID a few days prior,” he noted.
“By hard-wiring a process for early recognition of a patient's decline into the care pathway, and collaborating creatively with community partners to link hospital and home, better care is delivered and crisis can be averted. It's simple, it works and it is welcome support from patients at a frightening time.”
