A mixed methods evaluation of remote home monitoring models during the COVID-19 pandemic in the UK

Delays in the escalation of patient cases during the COVID-19 pandemic has led to the admittance of patients with advanced course of the disease, requiring invasive treatment and potential admission to ICU. Remote home monitoring models (sometimes referred to as 'virtual wards') seek to remotely monitor patients considered high-risk of deterioration at home to: 1) avoid unnecessary hospital admissions (appropriate care at the appropriate place), and 2) escalate cases of deterioration at an earlier stage to avoid invasive ventilation and ICU admission. Remote home monitoring models have been implemented in the US, Australia, Greece and UK, with some variation in the frequency of patient monitoring, modality (telephone or video calls and use of applications or online portals), patient criteria and use of pulse oximetry (Margolius et al. 2020; Karampela et al. 2020; Thornton 2020; Hutchings et al. 2020; Kricke et al. 2020; Annis et al. 2020; O'Keefe et al. 2020; Ford et al. 2020). In the UK, at least 10 remote home monitoring models have been documented with the aim outlined above (this does not include models operating as a step-down service following hospital inpatient stay). These models have mainly involved the following processes: 1) patient triage through 111, GP practice, hot hub (or ED for those pilots in secondary care), 2) patient provided with pulse oximeter, patient information (including escalation warning signs and what to do) and mechanism for recording observations regularly (app or paper diary) (potential observations being symptoms, pulse, heart rate, temperature, O2)., 3) patient receives regular monitoring calls from staff (either primary or secondary care depending on pilot). Symptoms and trends of O2 saturations are monitored. Modality/frequency of surveillance at clinician discretion. Calls are used to identify cases of deterioration and inform patient of next steps, and 4) Patients expected to 'check out' around 14 days mark (when recovery expected) - follow up to check symptoms and have oximeter and diary returned. Despite previous research on the use of remote home monitoring models for other conditions, there is a lack of studies on the implementation of these models for remote home monitoring during the COVID-19 pandemic. This mixed-methods evaluation of remote home monitoring models in the UK will seek to address this gap in two phases: (i) by capturing the lessons learnt during the implementation of these models during wave 1 of the pandemic and (ii) evaluating the implementation of the models during wave 2. The protocol has been developed during a four-week scoping exercise which has included initial scope of the literature (see appendix 2), discussions with each of the proposed sites (n=11), documentary analysis, and discussions with colleagues at PHE and NHSE. From discussions with a team from Imperial, our understanding is that they will be analysing retrospective data from sites operating during wave 1 of the pandemic provided to them by NHS Digital; therefore we are not proposing a quantitative analysis of outcomes in phase 1.