Push to keep Bucks patients at home
Wherever possible, care is being delivered away from the wards
Health services in Buckinghamshire are trying to keep patients at home wherever possible.
Covid patients are being offered home oxygen monitoring kits by Buckinghamshire's ambulance service in a UK first, whilst our NHS and social care teams are working on care in the community.
South Central's monitoring kits
The initiative, which began in Hampshire but is now running across the Thames Valley region, will ensure patients who have mild symptoms but have other risk factors, such as age over 65 years, cancer or other health conditions, can monitor their oxygen levels and know when to seek help.
The packs contain a pulse oximeter device, a symptom diary and a set of strict guidelines and are only distributed to patients who require emergency assessment by the ambulance service.
The development follows recent research by clinicians at SCAS which identified that just a slight drop in blood oxygen levels - but within the normal range - could be an early important warning sign of deterioration in patients before the onset of breathlessness.
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In most cases of bacteria and non-Covid pneumonia, shortness of breath appears relatively early in the disease and ahead of any significant drop in oxygen levels, known as hypoxia.
However, with Covid-19, a drop in oxygen levels often comes first, which is referred to as "silent hypoxia", and patients can be significantly unwell by the time they become breathless.
The team, which included SCAS Medical Director Dr John Black and Divisional Medical Director Professor Charles Deakin, studied almost 20,000 patients who called for an ambulance between March 1 and July 31 last year.
They then analysed the oxygen levels of 1,080 confirmed Covid positive patients at the point they were initially assessed by paramedics at home.
Patients whose blood oxygen levels dropped only 1% to 2% below 96% - still within the normal range of 94% to 98% - and showed no signs of shortness of breath often went on to require admission to intensive care and had a lower chance of survival.
Following the study, which was led by Dr Matthew Inada-Kim, a Consultant in General and Acute Medicine at Hampshire Hospitals NHS Foundation Trust and published as a pre-print via medRxiv, NHS England launched a nationwide rollout of its COVID Oximetry @home initiative.
The project involves supplying home pulse oximetry kits to people who test positive and are at higher risk of complications, such as those with health conditions and the over 65s, with around 300,000 supplied to patients across the country so far by local health systems.
The oximeters work by placing a clip on the end of a finger to measure oxygen in the blood and heart rate and, if oxygen levels drop to 94% or 93%, patients are asked to call their GP or NHS 111 - or 999 if it falls to 92% or less.
Dr. Black said:
"Our original research helped to inform the wider rollout of the COVID Oximetry @home project to enable patients in high-risk groups to monitor their blood oxygen levels directly and help ensure timely referral to hospital when indicated.
"We are now pleased to be the first ambulance service to offer pulse oximeters to patients along with guidance once we have assessed them and determined they don't need to be taken to hospital but are at increased risk of their condition changing.
"It provides patients with the reassurance that they can keep regular check on their oxygen levels independently and seek the help they need if their levels drop below 95%, while for us it means our clinicians can leave patients knowing they have the ability to spot any change promptly and take swift action."
Dr Inada-Kim, who is also the National Clinical Lead for Deterioration at NHS England, said:
"SCAS has produced groundbreaking research that has informed national policy and led to the evolution of the COVID home oximetry model and its staff are again leading the way with this new project to help identify patients at risk as early as possible."
An additional tab is being added to paramedics' electronic patient record devices to allow them to record the provision of a pulse oximeter to help with a retrospective review of the effectiveness of the initiative.
Dr Black added:
"It is hoped that prompt identification of hypoxia through home oximetry will lead to earlier admission to hospital for patients who subsequently deteriorate.
"This has the potential to improve the clinical outcomes of Covid-19 patients who develop complications."
If a patient does not suffer any further complications and makes a recovery at home they are asked to return the device after 14 days to their own GP Surgery or to their local COVID Oximetry @home service.
Think 'home first'
NHS and social care in Buckinghamshire are asking families to help support their loved ones when they return home from hospital.
Buckinghamshire Healthcare NHS Trust and Buckinghamshire Council have been working closely for a number of years to join up health and social care and ensure that as many people as possible receive treatment at home when it is safe and appropriate to do so, including after being discharged from hospital.
With the increased pressure of the pandemic on our local hospitals, this 'home first' approach has become even more important.
For some people, the medical, nursing and therapy care they need can be provided at home, which could prevent the need to go to hospital at all.
Families and carers play a vital role in helping to keep people safe and healthy at home.
Karen Bonner, Chief Nurse at Buckinghamshire Healthcare NHS Trust, said:
"Home First is about making sure our patients receive the right care, in the right place and making sure people who no longer need to be in hospital are able to return home as soon as it is safe for them to do so.
"The number of patients with COVID-19 in our hospitals is higher than in the first wave of the pandemic. So, if families can help us care for their loved ones in their own homes, this will open up more capacity in hospital for people who need to be treated there.
"And please don't worry - you won't be on your own. Our incredibly skilled team of community nurses and therapists are here to support you. But to do that they need you 'Home First'!"
Councillor Angela Macpherson, Deputy Leader and Cabinet Member for Adult Social Care at Buckinghamshire Council said:
"When a patient is ready to leave hospital we all want to ensure that they continue to receive all the support and care they need to continue on the path to full recovery. Often the best place for this is at home, in the care of their loved ones.
"We know this is an extremely unsettling time for everyone but we are able to offer a range of support and assistance to help families to cope and we will work with you in whatever way is needed."