Few COVID-19 patients in Los Angeles with pneumonia discharged on a practice of home oxygen use died or had to be readmitted to the hospital within 30 days, researchers found.
Among 621 patients discharged from either the hospital or the emergency department, the all-cause mortality rate was 1.3% (95% CI 0.6%-2.5%) and the 30-day all-cause hospital readmission rate was 8.5% (95% CI 6.2%-10.7%), reported Brad Spellberg, MD, of Los Angeles County/University of Southern California Medical Center, and colleagues, writing in JAMA Network Open.
They developed the SAFE @ HOME O2 Expected Practice, which stated that clinically stable patients with COVID-19 pneumonia requiring at least 3 L per minute of nasal cannula oxygen to achieve at least 92% oxygen saturation should be discharged to be treated in an ambulatory setting. Patients were dispensed the necessary equipment for home monitoring, such as a pulse oximeter, oxygen tank, and concentrator.
This practice also required patients discharged with oxygen to be called by a nurse, with physician support if necessary, within the first 12-18 hours after discharge. Calls were performed daily, 7 days a week, until patients showed that they understood both how to use the equipment and the indications for return care.
Spellberg and colleagues examined data from 621 patients with COVID-19 pneumonia from March 20 to August 19, 2020. Patients received either inpatient or emergency department care at two large urban medical centers, and were discharged with home oxygen.
Participants' median age was 51, two-thirds were men, and three-quarters were discharged from inpatient admissions. About three-quarters were insured by Medicaid, and about 85% spoke Spanish. Median follow-up was 26 days.
No patients died at home or during transport to acute care.
In addition, while a formal cohort analysis was not performed, hospital mortality for readmitted patients after a trial of home oxygen was "consistent with overall observed hospital mortality" for patients without a preceding or subsequent trial of home oxygen (15% vs 14%, respectively), the researchers said.
Limitations to the data, the team noted, include the observational nature and limited generalizability, as comparable data on acute care duration and patients not discharged and not requiring home oxygen was unavailable.
The authors concluded that this program "may be considered part of a strategy to ensure right care, right place, and right time for patients with COVID-19 pneumonia, and to preserve acute care access during the pandemic," and that the results underscore the program's safety.
Disclosures
The authors disclosed no conflicts of interest.
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