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 assess the potential for Remote Monitoring (RM) and rapid assessment of COVID-19 through Community Assessment Hubs (CAHs) to reduce the COVID-19 burden on hospitals and GP practices.
Problem solving
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 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?
- Remote Monitoring:
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 is assessing the impact of this RM solution on patient throughput and outcomes. The user acceptability and adherence to the programme is being explored to improve the programme and inform its potential use in other settings.
The RM part of the project is focusing on the Mater Hospital Covid-19 Virtual Clinic (MMUH CVC) and the ongoing monitoring of 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, so that they can be monitored effectively at home. Evidence is being gained about the experiences in this Mater clinic through the collection of survey and interview data from a cross-section of healthcare staff and patients who were referred to the clinics.
The development and analysis of the impact of this RM programme will generate learning for its expansion to other services.
2. Rapid Assessment of COVID-19 patients:
The HSE established Community Assessment Hubs (CAHs) to prevent GP clinics becoming overwhelmed with numbers of people presenting with COVID-19 symptoms; and to mitigate the risk of transmission of COVID-19 in GP practices.
The rapid assessment part of the project will evaluate the impact of these CAHs from a patient, staff, and GP perspective. The study sites are: HSE Mid-West, where three Covid-19 CAHs – Clare, Limerick and Tipperary were established, HSE South - Cork city CAH, and University Hospital Limerick. GPs referred deteriorating patients to these hubs for assessment and a decision to either refer to hospital or to self-isolate at home. The project also evaluates the impact of COVID related presentations at the Emergency Department in University Hospital Limerick.
There are several components to the study. Evidence is being gained about the experiences in the four CAHs through the collection of survey and interview data from a cross-section of healthcare staff and patients who were referred to the clinics. Retrospective analysis of patient data from the CAHs and the Emergency Department of the hospital that the CAHs refer to, is being used to help predict patient outcomes.
Research Impact
The successful roll-out and scale-up of these remote monitoring and rapid assessment interventions 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 and rapid assessment clinics 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. The study of rapid assessment of COVID-19 through Community Assessment Hubs is providing valuable insights from both patient.
and staff perspectives on the operation of CAHs. The study will provide insight into the effectiveness and acceptability of CAHs and propose areas for improvement of the service.
This research project commenced in October 2020 and is due for completion in May 2021.
The protocol for the rapid assessment of COVID-19 patients using Community Assessment Hubs has been published in HRB open: Mulcahy Symmons S, Fox R, Mannion M et al. A mixed methods protocol to evaluate the effectiveness and acceptability of COVID-19 Community Assessment Hubs [version 1; peer review: 1 approved with reservations]. HRB Open Res 2021, 4:16 (https://doi.org/10.12688/hrbopenres.13217.1)
Project Partners
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
Ms Una Cunningham, Head of Transformation, 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
Dr Eavan Muldoon, Consultant in Inclusion and Infectious Diseases, MMUH.
