Andrew Davis
As Utah’s COVID-19 cases started to spike in late summer and hospitals were filling up, Intermountain’s remote patient monitoring service was able to step in and help care for COVID-19 patients who were very sick and needed monitoring but not quite sick enough to be admitted to the hospital. The COVID-19 remote patient monitoring program allows for real-time at home monitoring of COVID-19 patients so they can stay at home and it prevents unnecessary return trips to the hospital.
Andrew Davis, the manager over the program, says they’ve served more than 2,000 COVID-19 patients since launching in August and they’re now monitoring an average of 400 patients at a time.
Intermountain’s remote patient monitoring service was in the planning stages in early 2020 and was fast-tracked once the pandemic hit. It was initially planned as a way to remotely monitor high-risk patients with chronic conditions, but when the pandemic worsened and the strain on hospitals increased, Joseph Bledsoe, MD, Intermountain’s director of research in the department of emergency medicine, contacted the team to see if their service could be adapted to help monitor COVID-19 patients.
Joseph Bledsoe, MD
“Patients were coming to the Emergency Department and they weren’t sick enough to be admitted,” says Dr. Bledsoe. “We would just tell them to go home until they got sicker, then come back. This was a gap in care that caused strain on the ED and put patients at risk of becoming very sick before getting back to the hospital. Remotely monitoring these patients at home seemed like a great solution.”
The remote patient monitoring team quickly came up with a way to help monitor these patients at home. Eligible patients are sent home with a kit that includes a pulse oximeter that monitors their oxygen levels and heart rate. The pulse oximeter can sync with the patient’s mobile device and sends the data to Intermountain’s remote monitoring center. The data is monitored around the clock by caregivers who can quickly escalate any concerns to a nurse or provider. The caregivers also regularly contact the patients to make sure they’re doing well. The monitoring typically lasts for two weeks.
Kerry Palakanis
“We’re tracking their oxygen levels,” says Kerry Palakanis, a nurse practitioner and the program’s executive director. “COVID-19 patients often develop silent hypoxia, where their oxygen saturation levels drop dangerously low. We’re able to monitor those oxygen levels and if they drop too low, we can get the patient help fast.”
Intermountain’s ED teams found there was a 40 percent chance that a patient would return to the ED again after being discharged without admission criteria for COVID-19, and many people came back to the ED multiple times. But for patients sent home with remote monitoring, only about 1 to 5 percent return to the ED per week. That’s a huge strain removed from emergency departments. And it’s helping ensure resources go to the people with greatest need.
“Having these types of programs available helps us safely keep patients in their own homes and reserves hospital beds for those who have higher levels of care requirements,” Dr. Bledsoe says.
Valerie Jackson
Valerie Jackson from Highland, Utah, was enrolled in the program in early September after going to the hospital with COVID-19 symptoms. Since she had no one at home to help monitor her health, doctors enrolled her in the remote patient monitoring program.
When her oxygen levels dropped, Valarie got a call from a nurse practitioner saying her numbers were too low and advising her to head to the hospital. She spent a few days in the hospital but is now home and giving thanks for a program she says saved her life and allows her to recover in the comfort of her home.
“I wouldn’t have known when to go to the hospital,” Valarie told FOX 13 news. “This brought such comfort to me and my family. Everyone was all so kind.”
“We deploy somewhere between 30 to 50 kits per day from the emergency departments throughout the system,” says Dr. Bledsoe. “It provides a really high level of reassurance knowing that you can check your oxygen levels anytime you want, but also knowing there’s someone on the other end who is checking to see if it’s abnormal and will call you and tell you what to do next.”
A pulse oximeter used by patients at home to monitor oxygen levels and heart rate
COVID-19 remote patient monitoring is available for all Intermountain emergency departments and was recently expanded to allow physicians the option to send patients home with oxygen, as well as the oximeter, if needed. It’s also being piloted for patients with high-risk pregnancies at the Layton, Utah Valley, and Cottonwood clinics and will hopefully be expanded to all Intermountain InstaCares and primary care clinics eventually.
Patients aren’t billed for COVID-19 remote patient monitoring. The program and equipment are funded through grants. Patients can keep the equipment after monitoring ends. Intermountain experts say the reduced load on the system thanks to less patients in the ED and fewer patients admitted to the hospital is well worth the cost.
Intermountain partners with a vendor called “Harmonize” for the take-home COVID-19 kits. Kerry says her team helped redesign and improve the Harmonize kit and the company is now using the redesigned version for all their clients nationwide.