Managing patients from home: Is it now a standard of care in Europe?
During the COVID-19 pandemic managing patients from home went from being a luxury to a necessity.
Healthcare services worldwide looked for efficient and safe solutions for remote patient monitoring.
In a webinar for the World Hospital at Home Community, Giovanni Sbrana, deputy director of the Arezzo emergency medical service (EMS) in Tuscany, Italy, discusses the challenges faced during the pandemic and how implementing Masimo SafetyNet helped manage COVID positive patients remotely.
Masimo SafetyNet is a cloud-based patient management platform featuring clinical-grade continuous and spot-checking measurements, digital care pathways, and remote patient surveillance.
Remote rural area
Arezzo EMS serves patients in the rural regions of Arezzo, Siena, and Grosseto, which have a very low-density population and a high number of elderly citizens with co-morbidities.
“The pandemic worsened the situation. There is no big roadway, just a small number of highways which makes it difficult to move patients from one place to another,” explains Sbrana.
The availability of hospitals was an issue with just one large hospital, the Siena University Hospital plus the Grosetto and Arezzo provincial hospitals having COVID wards. There are also two other hospitals in the area with intensive care units (ICUs) and eight small rural hospitals.
“You can understand the availability of hospitals was often a practical point in the area,” says Sbrana.
COVID crisis point
At the start of the first COVID pandemic period, the service’s chronic care model of therapy was thrown into crisis.
“People were unable to get to their doctors. We were trying to figure what had happened to their chronic obstructive pulmonary disease (COPD) patients who were isolated with no ambulatory service available and with problems accessing in the ambulatory service and so on. This resulted in a stressful period for EMS.”
The EMS needed a solution for isolated patients in these remote rural areas and decided to implement Masimo SafetyNet during the second COVID wave in November 2020.
It took just two weeks to get the solution running at full operational capacity and Masimo provided a complete structure, so no dedicated IT team was needed. The solution was used for 200 patients and achieved 80% home management.
Masimo SafetyNet was used in the home setting, the geriatric chronic setting and sometimes for early hospital discharge.
Patients were enrolled during hospital discharge both from wards and the emergency department (ED). ED patients were often presenting with low critical problems, fever and early diagnosis of COVID infection.
“We had a domiciliary unit of GPs who were able to enroll patients for monitoring. By merging these three teams we were able to cover a huge number of patients in a small period,” explains Sbrana.
Masimo SafetyNet sent patient monitoring data from wearable bracelets to patient’s smartphone via Bluetooth connection and from the smartphones to two EMS dispatch centres in Arezzo and Siena.
In each dispatch centre, there is always one emergency physician and one senior nurse on duty, who oversee receiving the data.
Depending on the kind of data received, the clinicians supervise dispatchers to either dispatch an emergency medicine vehicle, advise the patient over the phone or schedule a visit with the GP hospital team dedicated to COVID patients.
Points of strength
During November 2020 and January 2021, 70% of COVID hospital admissions were directly from home to hospital without going to the emergency department (ED).
“The Masimo SafetyNet was a tremendous asset, because by keeping the patient monitored, we can take them to the hospital immediately when they need it and they arrive at the hospital already stabilised and so there is no ED crowding,” says Sbrana.
Clinicians were able to trust the monitoring data because there were no false positive or false negatives.
“Accurate and reliable data is a very important thing. If you can’t rely on your data and monitoring system you won’t be able to keep the patient alone at home. We were able to take clinical decisions over our monitoring system. As the alarms arrived we were able to believe them,” says Sbrana.
One of the factors which contributed to the success of the project was having one link between EMS, GPs and the chronic care team at the hospital, meaning all stakeholders could see the monitoring data.
It was also important to have a well-defined patient pathway, so clinicians knew which patients would benefit from the monitoring system and what the limits were for sending a vehicle or GP team out or sending patients to the hospital.
Results of the project were monitored weekly to rectify anything which was not working correctly and help the success of the service.
‘No patient is alone’
The EMS adopted the motto ‘no patient is alone’ to reflect the project’s aim of helping COVID positive patients feel safe and cared for while staying at home.
“Not only were we able to provide monitoring and medical care at home, but also from a psychological point of view because old and elderly people at home sick with COVID feel alone and with this technology nobody is really alone,” says Sbrana.
“The expected advantages were to reduce ED access, reduce home access and reduce patient loneliness. You consume less resources while also helping the patient feel better and not feel alone,” he adds.
The wearable bracelet allows patients freedom because it can be worn while moving, sleeping or even taking a shower.
Data flows continuously meaning there is no need to constantly interact with patients to check their status, which is especially useful for the very elderly who are not able to use the telephone.
Although the project is still in operation, they are now happily monitoring only a very small number of COVID patients. Arezzo EMS is now working with Masimo to find solutions for patients with no smartphone available at home.
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