OP339 Virtual COVID Ward: The Use Of Telehealth In The Emergency Response To COVID-19

2021 ◽  
Vol 37 (S1) ◽  
pp. 14-14
Author(s):  
Abdel Hakim Rezgui ◽  
Rosemary Harkness ◽  
Hou Law ◽  
David Thomson ◽  
Rebecca Towns
Keyword(s):  
Oxygen Therapy ◽  
Clinical Status ◽  
Admission Rate ◽  
Mobile App ◽  
Early Warning Score ◽  
Hospital Inpatient ◽  
Oxygen Concentrator ◽  
Fraction Of Inspired Oxygen ◽  
Oxygen Requirements ◽  
Remote Consultations

IntroductionWith unprecedented times, comes accelerated change. Hospitals in our region have begun to facilitate safe discharge for COVID-19 patients in the form of “The virtual COVID ward”. This has enabled patients to be monitored safely in the community using pulse oximetry, Florence (a telehealth mobile app) and remote consultations. Our objective is to expand upon this model by providing home oxygen therapy for these patients facilitated by telemedicine.MethodsPatients were discharged with an oxygen concentrator if they had an oxygen requirement equal to or less than four litres/minute. Fraction of inspired oxygen needed to be stable and an early warning score of less than four was also required. Once admitted, the Florence app and daily remote consultations were crucial to closely monitor the patient's clinical status. The patient was instructed to enter oxygen saturations and heart rate into the app four times daily. The app would then alert our team if any patients observations deteriorate, triggering immediate assessment.ResultsWe have discharged ninety patients to the virtual ward, fifty-six of these with home oxygen. The average age was fifty-seven and the Clinical Frailty Score ranged between one and six. At present, ten patients have been re-admitted, four with increasing oxygen requirements, and six with unrelated symptoms. Two patients had oxygen concentrators installed at home after we were alerted to their desaturation by the Florence App. The re-admission rate is eleven percent, which mirrors that of other virtual wards (who do not provide home oxygen). In total, the ward has saved the trust 627 hospital inpatient ‘days’. Patients report increased satisfaction at playing a meaningful role in monitoring their own healthcare using the app.ConclusionsOur novel model of supported discharge with oxygen therapy using telehealth demonstrates that it is possible to manage such patients, safely, in the community. Other trusts could utilise this model to reduce inpatient bed occupancy. Looking to the future, could telehealth be utilised further to facilitate other “Virtual wards” in the community?

scholarly journals Mobile application to optimize care for STEMI patients in a large healthcare system, STEMIcathAID. Rationale and design

2021 ◽  
Author(s):  
Parasuram Krishnamoorthy ◽  
Andriy Vengrenyuk ◽  
Brian Wasielewski ◽  
Nitin Barman ◽  
Jeffrey Bander ◽  
...  
Keyword(s):  
Healthcare System ◽  
Mobile Application ◽  
Performance Metrics ◽  
Clinical Status ◽  
Coronary Intervention ◽  
Mobile App ◽  
Gps Tracking ◽  
St Segment Elevation ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory

Abstract Technological advancements have transformed healthcare. System delays in transferring patients with ST- segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) center are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication and coordination between the STEMI care teams to reduce ischemia time and improve patient outcomes. The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the EKG and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer center. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPPA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge important data elements have to be entered to close the case. In conclusion, we developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.

scholarly journals Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Andrew G. Weber ◽  
Alice S. Chau ◽  
Mikala Egeblad ◽  
Betsy J. Barnes ◽  
Tobias Janowitz
Keyword(s):  
Case Series ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Dornase Alfa ◽  
Extracellular Traps ◽  
Dnase 1 ◽  
Fraction Of Inspired Oxygen ◽  
Oxygen Requirements ◽  
Inspired Oxygen ◽  
Ventilated Patients

Abstract Background Mechanically ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system. Methods Demographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation—treated with nebulized in-line endotracheal dornase alfa and albuterol, between March 31 and April 24, 2020. Data on tolerability and response were analyzed. Results The fraction of inspired oxygen requirements was reduced for all five patients after initiating dornase alfa administration. All patients were successfully extubated, discharged from hospital and remain alive. No drug-associated toxicities were identified. Conclusions Results suggest that dornase alfa will be well-tolerated by patients with severe COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and several have been recently registered.

scholarly journals Evaluation of Knowledge of Oxygen Therapy and Reading of Flowmeter among the Health Workers in the Pediatric Unit of the Hospital Universitario San Ignacio, Bogotá, Colombia

2018 ◽  
Vol 59 (3) ◽  
pp. 1-8
Author(s):  
Elly Morros González ◽  
Diana Estrada Cano ◽  
Marcela Murillo Galvis ◽  
Jos Carlos Montes Correa ◽  
Nelcy Rodríguez Malagón ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Oxygen Saturation ◽  
Oxygen Therapy ◽  
Health Workers ◽  
Supplemental Oxygen ◽  
Cross Sectional Study ◽  
Peripheral Oxygen Saturation ◽  
Cross Sectional ◽  
Fraction Of Inspired Oxygen ◽  
Supplemental Oxygen Therapy

Introduction: Supplemental oxygen is considered a pharmaceutical drug; therefore, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and the peripheral oxygen saturation (SpO2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpO2 goals and reading of oxygen flowmeters among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied survey between December 2016 and January 2017. The poll evaluated topics on supplemental oxygen therapy fundamentals and adverse effects, SpO2 goals and flowmeter readings through flowmeters photographs indicating a specific fraction of inspired oxygen (FiO2). Results: The response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% of participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplemental oxygen concentration greater than required. In neonatal population, 10% considered oxygen saturation goals equal to or greater than 96%. In the flowmeter’s reading evaluation, incorrect answers ranged from 9 to 19%. Conclusion: It is imperative to reinforce updated concepts on oxygen therapy, with emphasis in SpO2 goals, adverse effects and appropriate flowmeter’s readings through periodic educational campaigns.

scholarly journals Predictors of successful separation from high-flow nasal oxygen therapy in patients with acute respiratory failure: a retrospective monocenter study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Maeva Rodriguez ◽  
Arnaud W. Thille ◽  
Florence Boissier ◽  
Anne Veinstein ◽  
Delphine Chatellier ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Rate ◽  
Oxygen Therapy ◽  
Preventive Treatment ◽  
High Flow ◽  
Multicenter Studies ◽  
First Line Therapy ◽  
Successful Separation ◽  
Fraction Of Inspired Oxygen

Abstract Background High-flow nasal oxygen therapy (HFOT) is a promising first-line therapy for acute respiratory failure. However, its weaning has never been investigated and could lead to unnecessary prolonged intensive-care unit (ICU) stay. The aim of this study is to assess predictors of successful separation from HFOT in critically ill patients. We performed a retrospective monocenter observational study over a 2-year period including all patients treated with HFOT for acute respiratory failure in the ICU. Those who died or were intubated without prior HFOT separation attempt, who were treated with non-invasive ventilation at the time of HFOT separation, or who received HFOT as a preventive treatment during the post-extubation period were excluded. Results From the 190 patients analyzed, 168 (88%) were successfully separated from HFOT at the first attempt. Patients who failed separation from HFOT at the first attempt had longer ICU length of stay than those who succeeded: 10 days (7–12) vs. 5 (4–8), p < 0.0001. Fraction of inspired oxygen (FiO2) ≤ 40% and a respiratory rate-oxygenation (ROX) index (calculated as the ratio of SpO2/FiO2 to the respiratory rate) ≥ 9.2 predicted successful separation from HFOT with sensitivity of 85% and 84%, respectively. Conclusions FiO2 ≤ 40% and ROX index ≥ 9.2 were two predictors of successful separation from HFOT at the bedside. Prospective multicenter studies are needed to confirm these results.

scholarly journals Can Early Clinical Status Predict Outcomes in Extremely Low Birth Weight Neonates?

2020 ◽  
Vol 10 (01) ◽  
pp. e32-e37
Author(s):  
Alok Kumar MK ◽  
Femitha Pournami ◽  
Sujith Kumar Reddy Gurram Venkata ◽  
Anand Nandakumar ◽  
Jyothi Prabhakar ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Clinical Status ◽  
Strong Association ◽  
Extremely Low Birth Weight ◽  
Perinatal Factors ◽  
Elbw Neonates ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Abstract Background Extremely low birth weight (ELBW) neonates are the sickest patrons of neonatal intensive care. Authors have attempted to predict outcomes based on perinatal factors very soon after birth. Allowing a longer duration for clinical assessment may permit meaningful assessments. Postponing these predictions to several weeks does not offer succour. Methods We retrospectively studied association of predefined perinatal factors and clinical status of 53 ELBW infants in the first 72 hours of life; with death or continued need for respiratory support at 4 weeks of life separately (RS4). Results Mean and standard deviations of birth weight and gestational age were 781.8 (±130.7) g (range: 510–990 g) and 26.4 (±1.5) weeks (range: 24–30 weeks), respectively; 32.9% were < 750 g at birth. Of the 53 neonates, 20.7% babies expired and 47.1% required RS4 (66% neonates suffered composite outcome of death/RS4). Need for > 0.3 fraction of inspired oxygen (FiO2) beyond 72 hours of life demonstrated strong association with death/RS4 (odds ratio [OR] 14.3; 95% confidence interval [CI] 3.2–63.0). Need for chest compression (OR 15.3; 95% CI 1.4–167.2) and shock (OR 14.2; 95% CI 2.7–72.8) were significantly associated with mortality. Conclusion FiO2 requirement of > 0.3 at 72 hours reasonably predicts death or dependence on respiratory supports at 4 weeks of life.

Multicenter Trial of Single-Dose Modified Bovine Surfactant Extract (Survanta) for Prevention of Respiratory Distress Syndrome

PEDIATRICS ◽  
1990 ◽  
Vol 85 (6) ◽  
pp. 1092-1102
Author(s):  
Roger F. Soll ◽  
Ronald E. Hoekstra ◽  
John J. Fangman ◽  
Anthony J. Corbet ◽  
James M. Adams ◽  
...  
Keyword(s):  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Airway Pressure ◽  
Distress Syndrome ◽  
Clinical Status ◽  
Supplemental Oxygen ◽  
Assisted Ventilation ◽  
Fraction Of Inspired Oxygen ◽  
Alveolar Oxygen ◽  
Inspired Oxygen

A multicenter, prospective randomized controlled trial was performed comparing the efficacy of a single intratracheal dose of modified bovine surfactant extract (Survanta, 100 mg/kg, Abbott Laboratory, North Chicago, IL) with air placebo in preventing respiratory distress syndrome. Infants were enrolled if they were estimated to be between 24 and 30 weeks' gestation, weighed between 750 and 1250 g, and were intubated and stabilized within 15 minutes after birth. A total of 160 infants were treated (79 with surfactant, 81 with air placebo) between 4 and 37 minutes after birth (median time 12 minutes). Of these, 5 infants were excluded from the final analysis. The 72-hour average values for the arterial-alveolar oxygen ratio, fraction of inspired oxygen, and mean airway pressure were calculated from the area under the curve of scheduled values measured throughout 72 hours. Clinical status was classified using five ordered categories (no supplemental oxygen or assisted ventilation, supplemental oxygen only, continuous positive airway pressure or assisted ventilation with intermittent mandatory ventilation ≤6 breaths/min, assisted ventilation with intermittent mandatory ventilation &gt;6 breaths/min, death). Chest radiographs at 24 hours were graded for severity of respiratory distress syndrome. Infants receiving Survanta had less severe radiographic changes at 24 hours of age and decreased average fraction of inspired oxygen (31% vs 42%, P = .002) compared with control infants. No differences were noted in the average arterial-alveolar oxygen ratio, mean airway pressure, or clinical status on days 7 and 28. A beneficial effect was noted in the incidence of pneumothorax (P = .057) and an increase was noted in the incidence of necrotizing enterocolitis (P = .052). No differences in incidence of patent ductus arteriosus, intraventricular hemorrhage, sepsis, or bronchopulmonary dysplasia were seen. According to results of a secondary analysis, there was improvement in the fraction of inspired oxygen and a greater number of survivors without bronchopulmonary dysplasia in the subgroup of infants weighing &lt;1000 g who were treated with surfactant. It was concluded that a single dose of Survanta given shortly after birth resulted in decreased severity of chest radiographic findings 24 hours after treatment and improved oxygenation during 72 hours after treatment, but did not improve other acute measures of disease severity or clinical status later in the neonatal period. The group at highest risk for respiratory distress syndrome (infants with birth weights between 750 and 999 g) may benefit the most from preventive therapy.

scholarly journals Development, Implementation, and Evaluation of an In-Hospital Optimized Early Warning Score for Patient Deterioration

2020 ◽  
Vol 5 (1) ◽  
pp. 238146831989966 ◽  
Author(s):  
Cara O’Brien ◽  
Benjamin A. Goldstein ◽  
Yueqi Shen ◽  
Matthew Phelan ◽  
Curtis Lambert ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Early Warning ◽  
Clinical Decision Making ◽  
Risk Model ◽  
Clinical Status ◽  
Area Under The Curve ◽  
Clinical Decision ◽  
Early Warning Score ◽  
Support Tool ◽  
National Early Warning Score

Background. Identification of patients at risk of deteriorating during their hospitalization is an important concern. However, many off-shelf scores have poor in-center performance. In this article, we report our experience developing, implementing, and evaluating an in-hospital score for deterioration. Methods. We abstracted 3 years of data (2014–2016) and identified patients on medical wards that died or were transferred to the intensive care unit. We developed a time-varying risk model and then implemented the model over a 10-week period to assess prospective predictive performance. We compared performance to our currently used tool, National Early Warning Score. In order to aid clinical decision making, we transformed the quantitative score into a three-level clinical decision support tool. Results. The developed risk score had an average area under the curve of 0.814 (95% confidence interval = 0.79–0.83) versus 0.740 (95% confidence interval = 0.72–0.76) for the National Early Warning Score. We found the proposed score was able to respond to acute clinical changes in patients’ clinical status. Upon implementing the score, we were able to achieve the desired positive predictive value but needed to retune the thresholds to get the desired sensitivity. Discussion. This work illustrates the potential for academic medical centers to build, refine, and implement risk models that are targeted to their patient population and work flow.

scholarly journals Oxygen Therapy

2000 ◽  
Vol 7 (5) ◽  
pp. 368-370
Author(s):  
Bonnie Solmes
Keyword(s):  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
The Body ◽  
Chronic Obstructive ◽  
Shortness Of Breath ◽  
Low Oxygen ◽  
Obstructive Pulmonary Disease ◽  
Arterial Blood ◽  
Oxygen Requirements ◽  
Supplemental Oxygen Therapy

LTOT is prescribed for people with chronic lung disease in whom there is a decrease in the ability of the lungs to supply enough oxygen to the body. The heart is obliged to pump faster to meet the body's oxygen requirements. This may place undue stress on the heart, resulting in palpitations, dizziness and fatigue. A low oxygen level in arterial blood is also harmful to the heart, the brain and the pulmonary blood vessels. Oxygen therapy is used to break this cycle. A person with low blood oxygen will often be able to accomplish more with less fatigue with the help of supplemental oxygen therapy. Shortness of breath is a mechanical problem resulting from the effects of chronic obstructive pulmonary disease. Oxygen therapy may or may not reduce shortness of breath, but it will help the lungs and heart to function with less stress.

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