Expanding Care Capacity through Remote Monitoring of Covid-19 patients
Lead Researchers: Professor Eilish McAuliffe, UCD Centre for Interdisciplinary Research Education and Innovation in Health Systems (IRIS) Centre and UCD School of Nursing, Midwifery and Health Systems.
Funder: Science Foundation Ireland/Enterprise Ireland/IDA Ireland joint Covid-19 Rapid Response Fund
Professor McAuliffe is leading an interdisciplinary consortium focusing on two Covid-19 care models: (1) The Mater Hospital’s virtual clinic where patients submitted ‘self-monitoring’ data using the HSE’s Covid-19App (developed by Irish digital health firm patientMpower); (2) HSE Mid-West’s Community Assessment Hubs to allow symptomatic patients rapidly access health expertise whilst reducing pressure on GP clinics.
The project aims to gather evidence about the experiences of patients and healthcare staff of engaging with remote monitoring to learn how not just covid patients but other patient groups could effectively manage their symptoms at home.
Access to primary care and hospital bed capacity are the two main health systems issues that continually challenge Ireland’s ability to deliver appropriate and timely healthcare. The Covid-19 pandemic has created substantial demands on an already over-stretched healthcare system.
The experience of other countries suggests that this demand will continue to escalate. Staffing shortages and high levels of Covid-19 amongst healthcare staff and nursing home residents (leading to a need for additional nursing staff in these facilities) present further challenges.
From the onset of the pandemic, individuals who are concerned about symptoms have been presenting to their GP in increasing numbers requesting testing. This has further exacerbated the well-documented primary care access and treatment problems due to Ireland’s low GP to population ratio.
Ireland’s over-stretched primary care system is not well-equipped to manage an escalating number of people presenting with Covid-19 symptoms. Late presentation to hospital and subsequent rapid deterioration resulting in more patients requiring admission to the intensive care unit (ICU) is a considerable concern, given our low ratio of ICU beds to population size compared to other countries.
The ability to detect deterioration in symptomatic and Covid-19 positive patients early in the disease progression and direct the patient to the appropriate level and place for care would have a substantial impact on efficient resource utilisation. During and beyond this pandemic it is imperative to ensure maximum efficiency in the utilisation of these scarce resources
What will the research project do?
One initiative with potential to increase efficiency in treating Covid-19 patients is remote monitoring (RM) of symptoms and pulse oximetry (blood oxygen saturation levels). PatientMpower Ltd, an Irish digital health firm, has developed an RM solution for Covid-19. This enables home monitoring of otherwise healthy patients with mild to moderate symptoms (not requiring hospitalisation) who are in self-isolation, Covid-19+ and/or symptomatic.
Key data (pulse oximetry, dyspnoea (sudden and severe shortness of breath)) recorded by the patient using a smartphone app can be viewed in real time by clinical staff. In this project, the team will assess the impact of this RM solution on patient throughput and outcomes, and explore the user acceptability and adherence to the programme to improve the programme and inform its potential use in other settings.
The project will focus on two sites:
1) The Mater Hospital Covid-19 Virtual Clinic (MMUH CVC) monitoring patients who have used the app at home. The aim of the clinic is to support the Infectious Diseases (ID) team with operational and clinical issues pertaining to discharged patients, in order to free time for in-patients.
2) Community Health Organisation 3, HSE Mid-West, where three Covid-19 Community Assessment Hubs – Clare, Limerick and Tipperary – were established to prevent patients from overburdening the hospital system. GPs can refer deteriorating patients to these hubs for assessment and a decision to either refer to hospital or to self-isolate with RM at home.
The development and analysis of the impact of this RM programme will generate learning for its expansion to other services.
The successful roll-out and scale-up of this remote monitoring intervention will have immediate benefits to patient safety and service quality in both primary care and hospital settings.
Health systems impacts:
This innovation has the potential to dramatically increase the numbers of patients that are efficiently and safely managed by clinical services during the Covid-19 pandemic. Learning from this project will also aid implementation of remote monitoring for other patient cohorts post-Covid-19.
In the primary care setting, impacts include:
- Reduced risk of transmission associated with attending GP practices, since patients can maintain self-isolation.
- Greater reassurance for patients and GPs from continuous monitoring.
- Faster response and hospital referral if patient condition deteriorates
In the hospital setting, impacts include:
- Mitigation of transmission risk associated with contact between patients and staff who inevitably attend other patients in the hospital.
- Reduction in unnecessary hospital bed occupancy.
- Greater efficiency in allocation of staff time so that more specialist staff are only called on if the patient’s symptoms escalate.
More broadly, the intervention has the potential to transform delivery of primary care, by maximising the use of clinical expertise in a setting where the current GP to population ratio is causing significant access problems. In addition, it is likely to result in considerable cost savings in the delivery of primary care.
By improving our understanding of acceptability of the remote monitoring device, and barriers/enablers of adherence among patients and healthcare staff, the project will enable improved sustainability and aid the spread of this technology.
Dr Aoife De Brún, UCD School of Nursing, Midwifery and Health Systems
Professor Katherine O’Reilly, Consultant Respiratory and Acute Medicine Physician, Mater Misericordiae University Hospital (MMUH) and UCD School of Medicine
Professor Liam Glynn, Professor of General Practice, Graduate Entry Medical School, University of Limerick
Dr Aoife Cotter, Associate Professor/Consultant in Infectious Diseases MMUH
Dr Philip Crowley, National Director, Quality Improvement, HSE and part-time GP
Professor Richard Costello. Consultant Chest Physician, Beaumont Hospital and Professor, Department of Medicine, Royal College of Surgeons Ireland
Ms Una Cunningham, Head of Transformation, MMUH
Ms Maria Creed, Pharmacist and Project Manager MMUH Covid Virtual Clinic, MMUH
Mr Alan Sharp, CEO, MMUH
Mr Eamonn Costello, CEO, patientMpower Ltd.
Dr Colin Edwards, Chief Scientific Officer, patientMpower Ltd.
Dr Sabrina Anjara, UCD IRIS Centre and UCD School of Nursing, Midwifery and Health Systems
Dr Steven MacDonald, Lecturer in Public Health, University of Limerick.
Dr Damien Ryan, Consultant in Emergency Medicine, University Hospital Limerick
Dr Tara McGinty, Consultant in Inclusion and Infectious Diseases, MMUH