Developing a pulse oximetry home monitoring protocol for patients suspected with COVID-19 after emergency department discharge

ObjectivesPatients with COVID-19 can present to the emergency department (ED) without immediate indication for admission, but with concern for decompensation. Clinical experience has demonstrated that critical illness may present later in the disease course and hypoxia is often the first indication of disease progression. The objectives of this study are to (a) assess feasibility and describe a protocol for ED-based outpatient pulse-oximetry monitoring with structured follow-up and (b) determine rates of ED return, hospitalisation and hypoxia among participants.MethodsProspective observational study of patients presenting to a single academic ED in Boston with suspected COVID-19. Eligible patients were adults being discharged from the ED with presumed COVID-19. Exclusion criteria included resting oxygen saturation <92%, ambulatory oxygen saturation <90%, heart rate >110 beats per minute or inability to use the device. Study personnel made scripted phone calls on postdischarge days 1, 3 and 7 to review the pulse-oximetry readings and to evaluate for decompensation. Return visit and admission information were collected via medical record and 28-day follow-up calls.Results81 patients were enrolled of which 10 (12%) developed hypoxia after their initial discharge from the ED. Overall, 23 (28%) of the 81 patients returned to the ED at least once and 10 of those who returned (43%) were admitted. We successfully contacted 76/81 (94%) of subjects via phone at least once for follow-up assessment.DiscussionPatients are eager and willing to participate in home monitoring systems and are comfortable with using technology, which will allow providers and health systems to extend our hospitals capabilities for tracking patient populations in times of crisis.ConclusionsIt is feasible to implement an outpatient pulse-oximetry monitoring protocol to monitor patients discharged from the ED with confirmed or suspected COVID-19.

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Adherence to emergency department discharge prescriptions

CJEM ◽

10.1017/s148180350001109x ◽

2009 ◽

Vol 11 (02) ◽

pp. 131-138 ◽

Cited By ~ 23

Author(s):

Corinne M. Hohl ◽

Riyad B. Abu-Laban ◽

Jeffrey R. Brubacher ◽

Peter J. Zed ◽

Boris Sobolev ◽

...

Keyword(s):

Emergency Department ◽

Health Services ◽

Prospective Observational Study ◽

Tertiary Care ◽

Related Event ◽

Convenience Sample ◽

Emergency Department Discharge ◽

Lower Odds Ratio ◽

Use Of Health Services

ABSTRACTObjective:Nonadherence to prescribed medication is associated with increased morbidity and mortality as well as the increased use of health services. The main objective of our study was to assess the incidence of prescription-filling and medication adherence in patients discharged from the emergency department (ED).Methods:This was a prospective, observational study carried out at a Canadian tertiary care ED with an annual census of 69 000. We enrolled a convenience sample of patients being discharged with a prescription. We queried a provincial prescription-dispensing database 2 weeks later to determine whether prescriptions had been filled. We used a standardized follow-up interview to assess adherence and whether or not the patient experienced an adverse drug-related event (ADRE) or an unplanned revisit to an ED or clinic.Results:Of the 301 patients who agreed to participate, follow-up was successful for 258 (85.7%). Fifty-one patients (19.8%, 95% confidence interval [CI] 15.4%–25.1%) failed to fill their discharge prescriptions and 104 (40.3%, 95% CI 34.5%–46.4%) did not adhere to 1 or more medications. Antibiotics were associated with a lower odds ratio (OR) of nonadherence (OR 0.21, 95% CI 0.08–0.52). There was a trend toward increasing nonadherence in patients who reported an ADRE (OR 1.84, 95% CI 0.98–3.48) or had 2 or more medications coprescribed (OR 1.71, 95% CI 0.95–3.09). There was also a trend toward a higher risk of a revisit to an ED or clinic in nonadherent patients (OR 1.75, 95% CI 0.94–3.25).Conclusion:Approximately 4 in 10 patients discharged from the ED did not adhere to his or her prescribed medication. Our results suggest that patients who are prescribed antibiotics are more likely to be adherent, and that further evaluation of the associations between nonadherence, ADREs, the coprescription of 2 or more medications and the use of health services is warranted.

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P068: Significance of asymptomatic oxygen desaturation in elderly ED patients: A pilot study

CJEM ◽

10.1017/cem.2019.259 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S87-S88

Author(s):

L. Johnston ◽

G. Innes

Keyword(s):

Elderly Patients ◽

Oxygen Saturation ◽

Pulse Oximetry ◽

Assisted Living ◽

Adverse Outcomes ◽

Low Oxygen ◽

Phone Calls ◽

Hypoxia Group ◽

Sustained Hypoxia

Introduction: Pulse oximetry is a standard component of Emergency Department (ED) patient monitoring. Pulse oximetry measures peripheral capillary oxygen saturation (SpO2) levels and can be used to monitor cardiorespiratory conditions. The normal SpO2 level for adults is approximately 96%. Oxygen saturations of <92% are considered problematic and levels <90% may indicate cardiorespiratory disease. However, low oxygen saturations are often seen in elderly patients with comorbidities. This research investigated the significance of hypoxia in asymptomatic older ED patients with no apparent acute illness. Methods: ED patients >75 years with a documented room air pulse oximetry reading <92% were eligible. Exclusion criteria included dyspnea, chest pain, SBP <100mmHg, HR >120 or <50; sustained tachypnea (RR > 20); acute cardiopulmonary conditions, delirium or acutely altered mentation. Eligible patients were separated into two groups: 1) Sustained hypoxia: two or more SpO2 readings <92% 2) Unsustained hypoxia: one SpO2 reading <92%. 30-day adverse events were tracked using a Sunrise Emergency Care record review. Adverse outcomes investigated included death, MI, CHF, PE, cardioversion, ICU admission, intubation, ED revisit or re-hospitalization. Patient characteristics studied were age, sex, arrival mode, triage complaint, CTAS level, pulse, BP, RR, weight, residence (independent, assisted living, facility), comorbidities, PHN, referral, disposition, and test results (CXR, troponin, ECG, CT). Follow-up phone calls were completed after 30 days to assess patient status and confirm ED revisit. Results: A total of 876 ED patients >75 years were screened and 30-day follow-up data was analyzed for 34 enrolled patients. The sustained hypoxia group (n = 23) showed higher rates of 30-day adverse outcomes of death, ED re-visitation, MI, CHF, a severe episode of COPD, PE and ICU stays compared to the unsustained hypoxia group (n = 11). Administrative data of 31,095 patients >75 years from four Calgary EDs in 2017 was also analyzed and 7,771 (20%) were hypoxic at triage (SpO2 <92%). Adverse outcomes and mortality were significant in discharged hypoxic patients (especially if SpO2 <90%). Conclusion: ED re-visits, cardiorespiratory complications, and mortality were significant in discharged sustained hypoxic patients, especially if O2 sat <90%. Pulse oximetry assessment of oxygen saturation in seniors’ care facilities and physicians’ offices may be important in screening for future adverse health outcomes in elderly patients.

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Accuracy of two pulse-oximetry measurements for INTELLiVENT-ASV in mechanically ventilated patients: a prospective observational study

Scientific Reports ◽

10.1038/s41598-021-88608-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shinshu Katayama ◽

Jun Shima ◽

Ken Tonai ◽

Kansuke Koyama ◽

Shin Nunomiya

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

Prospective Observational Study ◽

Arterial Oxygen Saturation ◽

Arterial Oxygen ◽

Arterial Blood Gas ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Ventilated Patients

AbstractRecently, maintaining a certain oxygen saturation measured by pulse oximetry (SpO2) range in mechanically ventilated patients was recommended; attaching the INTELLiVENT-ASV to ventilators might be beneficial. We evaluated the SpO2 measurement accuracy of a Nihon Kohden and a Masimo monitor compared to actual arterial oxygen saturation (SaO2). SpO2 was simultaneously measured by a Nihon Kohden and Masimo monitor in patients consecutively admitted to a general intensive care unit and mechanically ventilated. Bland–Altman plots were used to compare measured SpO2 with actual SaO2. One hundred mechanically ventilated patients and 1497 arterial blood gas results were reviewed. Mean SaO2 values, Nihon Kohden SpO2 measurements, and Masimo SpO2 measurements were 95.7%, 96.4%, and 96.9%, respectively. The Nihon Kohden SpO2 measurements were less biased than Masimo measurements; their precision was not significantly different. Nihon Kohden and Masimo SpO2 measurements were not significantly different in the “SaO2 < 94%” group (P = 0.083). In the “94% ≤ SaO2 < 98%” and “SaO2 ≥ 98%” groups, there were significant differences between the Nihon Kohden and Masimo SpO2 measurements (P < 0.0001; P = 0.006; respectively). Therefore, when using automatically controlling oxygenation with INTELLiVENT-ASV in mechanically ventilated patients, the Nihon Kohden SpO2 sensor is preferable.Trial registration UMIN000027671. Registered 7 June 2017.

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Follow-up trends after Emergency Department discharge for acutely symptomatic hernias

The American Journal of Surgery ◽

10.1016/j.amjsurg.2017.08.028 ◽

2017 ◽

Vol 214 (6) ◽

pp. 1018-1021 ◽

Cited By ~ 2

Author(s):

Lara Spence ◽

Eric Pillado ◽

Dennis Kim ◽

David Plurad

Keyword(s):

Emergency Department ◽

Emergency Department Discharge

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Ambulatory Follow-up and Outcomes Among Medicare Beneficiaries After Emergency Department Discharge

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.19878 ◽

2020 ◽

Vol 3 (10) ◽

pp. e2019878

Author(s):

Michelle P. Lin ◽

Ryan C. Burke ◽

E. John Orav ◽

Tynan H. Friend ◽

Laura G. Burke

Keyword(s):

Emergency Department ◽

Medicare Beneficiaries ◽

Emergency Department Discharge

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Improving Outpatient Follow-Up Through Innovative Appointment Scheduling at Emergency Department Discharge

Advanced Emergency Nursing Journal ◽

10.1097/tme.0000000000000340 ◽

2021 ◽

Vol 43 (1) ◽

pp. 71-78

Author(s):

Ashley Tessitore ◽

Jill Brennan-Cook

Keyword(s):

Emergency Department ◽

Appointment Scheduling ◽

Emergency Department Discharge

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283 Automated Follow-Up Text Messages to Identify Unmet Needs at Emergency Department Discharge: A Pilot Study

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2019.08.241 ◽

2019 ◽

Vol 74 (4) ◽

pp. S112

Author(s):

G. Fuller ◽

S. Tat ◽

I. Green-Hopkins

Keyword(s):

Emergency Department ◽

Pilot Study ◽

Unmet Needs ◽

Text Messages ◽

Emergency Department Discharge

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Tele-Follow-Up of Older Adult Patients from the Geriatric Emergency Department Innovation (GEDI) Program

Geriatrics ◽

10.3390/geriatrics4010018 ◽

2019 ◽

Vol 4 (1) ◽

pp. 18 ◽

Cited By ~ 4

Author(s):

Lucy Morse ◽

Linda Xiong ◽

Vanessa Ramirez-Zohfeld ◽

Scott Dresden ◽

Lee Lindquist

Keyword(s):

Older Adults ◽

Emergency Department ◽

Social Services ◽

Care Coordination ◽

Symptom Management ◽

Comparative Method ◽

Patient Needs ◽

Time Points ◽

Phone Calls

The objective of this study was to characterize the content and interventions performed during follow-up phone calls made to patients discharged from the Geriatrics Emergency Department Innovation (GEDI) Program and to demonstrate the benefit of these calls in the care of older adults discharged from the emergency department (ED). This study utilizes retrospective chart review with qualitative analysis. It was set in a large, urban, academic hospital emergency department utilizing the Geriatric Emergency Department Innovations (GEDI) Program. The subjects were adults aged 65 and over who visited the emergency department for acute care. Follow-up telephone calls were made by geriatric nurse liaisons (GNLs) at 24–72 h and 10–14 days post-discharge from the ED. The GNLs documented the content of the phone calls, and these notes were analyzed through a constant comparative method to identify emergent themes. The results showed that the most commonly arising themes in the patients’ questions and nurses’ responses across time-points included symptom management, medications, and care coordination (physician appointments, social services, therapy, and medical equipment). Early follow-up presented the opportunity for nurses to address needs in symptom management and care coordination that directly related to the ED admission; later follow-up presented a unique opportunity to resolve sub-acute issues that were not addressed by the initial discharge plan and to manage newly arising symptoms and patient needs. Thus, telephone follow-up after emergency department discharge presents an opportunity to better connect older adults with appropriate outpatient care and to address needs arising shortly after discharge that may not have otherwise been detected. By following up at two discrete time-points, this intervention identifies and addresses distinct patient needs.

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