23 March 2021
AHSN NETWORK BLOG: What do you know about pulse oximeters? If you work in a hospital, this simple device will no doubt be extremely familiar. You might have seen one at your GP, but not known what it’s called. And if you’re in a high-risk category, you may have been offered one to monitor the oxygen levels in your blood at home if you’ve had coronavirus.
For the uninitiated, a pulse oximeter is a small electronic device that clips onto the end of your finger. It measures your pulse but can also tell you how much oxygen is in your blood, by shining a light into your finger and analysing the information that comes back.
While the technology has moved on considerably, making the devices smaller, cheaper, easier to use and more accurate, health professionals have been using devices like this in hospitals and GP surgeries for almost 50 years.
By taking this technology out of health settings and providing pulse oximeters at home to people at risk of becoming seriously ill with coronavirus, frontline NHS teams have transformed how we provide primary and community care for people with coronavirus since the start of the pandemic.
In the first Covid peak, clinicians across the country reported seeing patients arrive for assessment sometimes with an absence of significant symptoms, but with extremely low oxygen levels - occasionally at a level past the point of saving.
They wondered if the patient had presented earlier, could the outcome have been different – but in the absence of any noticeable symptoms, how could those patients or anyone they spoke to know they needed to go to hospital earlier?
This question led to many local areas rapidly setting up COVID Oximetry @home services, where people are taught how to monitor themselves at home with pulse oximetry, as well as being taught about spotting other signs of deterioration and when to seek help.
By linking the devices with a digital app, or recording oxygen readings on paper, people’s results can be fed back to clinicians who can monitor them remotely, calling them into hospital for face-to-face care if their levels drop too low.
This work has been game changing.
Early evidence suggests that a small reduction in oxygen levels accurately predicts those who are likely to go on to have bad outcomes, and staff and patients tell us time and again that these vital services have gone on to save lives.
This bottom-up revolution has had a massive impact, it is now nationally recommended and implemented across 100% of CCGs in England, and 94% of hospitals which are now providing similar ‘COVID virtual ward’ services to support people who are leaving hospital.
People like Julia, a headteacher from Middlesbrough who was treated at the James Cook Hospital in South Tees know only too well how vital these services have been:
“I believe I owe my life to James Cook and in particular, the role the virtual ward played in looking after me. I could never thank them enough. The foresight and ingenuity in setting up such a system is commendable and should be recognised on a national level.”
For me, what’s particularly exciting is how clinicians have been inspired to lead and create local networks for change, and how we’ve come together across the country as a growing collective of clinicians, healthcare managers and system leaders to create a way of working which is now arguably world leading (the World Health Organisation now conditionally recommends home monitoring using pulse oximetry as part of a package of care for certain populations, as of January 2021).
It’s an old adage that necessity is the mother of invention, and the necessity to keep services running as safely as possible during the Covid pandemic has certainly seen accelerated invention of new ways of providing care, including digital pathways and providing a blueprint for more personalised care in the community across a whole host of other conditions, including COPD, asthma, heart failure, hypertension, and diabetes.
There’s already fantastic work afoot for example to provide blood pressure monitors to thousands of people with poorly controlled blood pressure so they can monitor their condition at home on a regular basis, rather than at the GP, where this works for the individual.
And we announced last year that thousands of people living with cystic fibrosis would be given spirometers and apps to help them and their clinicians monitor their lung capacity from home – an imperative borne of safety considerations during a pandemic, but also one which is more convenient for many.
These are just three examples of the work of the national NHS @home programme, which I’m proud to be part of, and we’ll be using what we’ve learnt from the very humble pulse oximeter to foster sustainable change that has the potential to empower patients everywhere.
Further information and support
In her NHSX blog published today, Tara Donnelly describes the progress being made to implement tech-enabled COVID virtual wards, now in place across 85 organisations.
Support and resources such as webinars, guidance and discussion forums are available to health and care colleagues who are interested in this work or remote monitoring for other conditions, through these networks on FutureNHS:
If you’re an NHS, social care or local authority staff member and you’re not already a member you can set up an account by submitting a request for access on the Future NHS website.
Alternatively email the national team: firstname.lastname@example.org
Matt Inada-Kim is an Acute Medicine Consultant at the Royal Hampshire County Hospital, Hampshire Hospitals Foundation Trust.
He is also National Clinical Director for Infection, Antimicrobial Resistance and Deterioration.