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Remote-monitored Covid patients encouraged to call GP if oxygen saturation drops to 93-94%


pulse oximetry


Patients are being encouraged to call their GP if their oxygen saturation drops to 93% or 94% as part of NHS England’s Covid ‘Oximetry @home’ scheme.

It was revealed last month that NHS England is to make 200,000 pulse oximeters available to enable primary care practitioners to monitor high-risk Covid-19 patients remotely at home.

The standard operating procedures for the scheme, published last week, recommended that all CCGs put the model in place ‘as rapidly as possible during November’.

According to the document, the ‘default assumption is that the model is primarily implemented in general practice, e.g. including in hot hubs, working with community teams’.

This could be through individual primary care networks (PCNs) or a ‘a single community health service’, it added.

The pathway is open to patients who are diagnosed with coronavirus clinically or by positive test result and are symptomatic and over 65 or under 65 and clinically extremely vulnerable to Covid, NHS England said.

Patients will be referred to the scheme by the 111 Covid clinical assessment service (CCAS), the Government’s Test and Trace scheme and hospital emergency departments, it added.

Those referred to the service should have a ‘standard’ assessment ‘as soon as possible and ideally the same day as the referral’, including the ‘potential for face-to-face clinical assessment if deemed necessary’, it said.

Once onboarded, patients should be encouraged to record their oxygen levels ‘usually three times a day’ and followed up with text or email ‘prompts’ or ‘check-in calls’ at days two, five, seven, 10 and 12, the document said.

It added: ‘Patients should be instructed to attend their nearest emergency department within an hour, or call 999 if their saturation reading is 92% or less, or to contact 111/GP if 93% or 94%.’

A spokesperson for NHS England told Pulse that such patients should be considered for further clinical assessment.

And patients onboarded to the scheme with oxygen levels of 93-94% should be managed with ‘more intense clinical assessment and oversight in the community’, the document added.

Kent LMC medical secretary Dr John Allingham told Pulse he has concerns about the workload this could create for practices.

He said: ‘In practice, I think what will happen is if you give the general public pulse oximeters, they’ll be doing their oxygen saturation every five minutes and ringing general practice every five minutes as well. 

‘That’s the danger – that it won’t be done at prescribed intervals in a way that can be managed, it will just be done randomly.’

He added: ‘To be honest, if you’ve tested positive for Covid and your oxygen saturation has dropped, there’s not a lot a GP can do.

‘Clinically if there’s a definite drop in your oxygen saturation and you’re Covid positive, I’m probably going to send you to hospital anyway.’

Meanwhile, those who show no signs of deterioration within 14 days of starting symptoms should be ‘actively discharged’ and provided ‘leaving information’ and safety netting, NHS England added.

They should also be given ‘safe’ advice on how to return their oximeter, such as directly to a ‘hot’ site, via a friend or family member or through the NHS Volunteer Responders, it said.

The document added that NHS England has written to CCGs about the £150m funding pledged to expand general practice capacity – and cover all additional GP Covid costs until March. 

Updated guidance published in August had encouraged practices to work together to use pulse oximetry ‘where available locally’ to help manage patients at home.

Meanwhile, GPs in Wales are being advised to do face-to-face pulse oximetry.

READERS' COMMENTS [11]

Pradeep Bahalkar 17 November, 2020 10:42 am

“It added: ‘Patients should be instructed to attend their nearest emergency department within an hour, or call 999 if their saturation reading is 92% or less, or to contact 111/GP if 93% or 94%.’” umhhhhhhh ……. ,Agree with 1st part of the sentence but , what a GP supposed to do if saturation has dropped to 93 or 94 % in pt who is COVID 19 Positive ? There is not a lot we can offer except asking him to attend A&E because he will need more closer monitoring and probably supplemental oxygen . GP service cannot provide neither.

patients onboarded to the scheme with oxygen levels of 93-94% should be managed with ‘more intense clinical assessment and oversight in the community’, the document added. Can some one who is wiser than me explain what do they mean by above sentence .What can GP surgery offer ???????

Robert James Andrew Mackenzie Koefman 17 November, 2020 10:44 am

And then ?

Patrufini Duffy 17 November, 2020 11:36 am

The patient and your GMC come first. The sats come last. The only relevent question is – are you getting worse, and use your brain, not some dumb algorithm, checklist grid. No one will thank you when a patient dies because of a plasterboard scheme. You are not AE, you are not ITU nor a respiratory consultant. You’re a GP.

Michael Mullineux 17 November, 2020 11:36 am

Onboarded???
We have been supplying Sats monitors to aide remote assessment since March when we purchased a job lot whilst the local obsession with hot and cold hubs raged. Fortunately, few patients have required any further intervention in our locality with steadily maintained Sats and these have served as a reassurance rather than requiring anything else (admission!). The NHSE advice about recurrently checking in with patients constitutes the usual micromanaging infantilisation so beloved by those who are keen on telling others what to do rather than being involved themselves.

Nathaniel Dixon 17 November, 2020 1:16 pm

Anyone honestly going to say if they’ve got covid and their sats are 93-94% they would think it’s best to call a GP? Personally I’d it was me I’d be off to hospital ASAP. That being the case surely this is also the advice we should be giving our patients.

David Banner 17 November, 2020 1:17 pm

NHSE throwing GPs under the bus yet again. They know damn well that there is nothing we can offer these patients, just gamble on keeping them at home in the hope they might pick up. It’s a cheap ‘n’ cheerful way of reducing admissions, and if there’s a fatal delay then it’s the GP’s fault. Job done.

Simon Gilbert 17 November, 2020 1:59 pm

Why, 6 months into the pandemic, are we still fixated on oxygen saturations?
Unwell Covid patients, or those with ongoing fever at 7-10 days, need more than just oxygen.
They might need: imaging; venous bloods; blood gas; regular monitoring from a nurse; iv fluids; antibiotics; low molecular weight heparin; decisions on ceilings of care; nutritional support; physical care; avoidance of pressure sores; and all of that without even considering ventilatory support from supplemental oxygen up to full ventilation.

Gary Free 17 November, 2020 5:27 pm

Silent hypoxia and evidence that shows can reduce mortality by doing stas at home. It’s pretty clear we have no capacity to deliver.

Dr N 17 November, 2020 6:22 pm

‘more intense clinical assessment and oversight in the community’. I haven’t a clue what that means – management tripe. They need CXR – D-dimer etc etc which has to be done in a big big hospital.

Dave Haddock 18 November, 2020 11:07 am

A good example of why so many of us took early retirement and how NHS England is unfit for purpose.

James Weems 18 November, 2020 10:49 pm

If anyone covid positive rings me with sats of 93pc I shall simply give 111 advice…