JAMA Network: Remote Patient Monitoring During COVID-19

COVID-19 has advanced patient safety in an unexpected way. Before the COVID-19 pandemic, patient monitoring for harm and many approaches to prevent harm were linked to where the patient was treated in the hospital.

A report based on data prior to the COVID-19 pandemic suggested that routinely monitoring hospitalized patients with continuous pulse oximetry and heart rate devices was associated with reduced mortality. In that study, arly recognition of hypoxemia and respiratory depression were largely responsible for the observed decrease in mortality, from 0 deaths among 111 ,487 patients in monitored units vs 3 deaths among 15 ,209 patients in unmonitored units. COVID-19 created a need to monitor patients treated in standard medical units, in emergency departments (EDs), and to also monitor some patients at home for clinical deterioration (eg, hypoxemia) to help increase hospital capacity. With the increased volume of patients coupled with high staffing ratios for all types of clinician workload, hospitalized patients are at increased risk for unrecognized clinical deterioration.

A recent cost-utility analysis estimated that daily assessment and 3-week follow-up of at-home pulse oximetry monitoring was projected to be potentially associated with a mortality rate of 6 per 1,000 patients with COVID-19, compared with 26 per 1,000 without at-home monitoring. Based on a hypothetical cohort of 3,100 patients, the study projected that remote monitoring could potentially be associated with 87 percent fewer hospitalizations, 77 percent fewer deaths, reduced per-patient costs of $11, 472 over standard care, and gains of 0.013 quality-adjusted life-years.

Patients can now be monitored based on risks and needs rather than location in the hospital. While enhanced monitoring at home could potentially improve safety and value, empirical evidence of the benefits of this approach are limited. Home monitoring and hospital at-home models offer the potential to transform care and potentially allow a substantial proportion of hospitalized patients to receive care from home. Yet, health systems will need to collaborate with technology companies to accelerate learning and produce greater value for patients, clinicians, and health care organizations.