Some coronavirus patients who would have been admitted into the
emergency department at a New York hospital are being sent home with an
oxygen-monitoring device as the city’s medical system struggles to
reserve resources for only the sickest people.
The new program at NewYork-Presbyterian Hospital is an example of how
doctors are adapting and loosening normal protocols to ease the strain
on emergency rooms and intensive care units in New York state, the
epicenter of the coronavirus pandemic in the United States.
Since last week, more than 200 people with confirmed or suspected
COVID-19, the respiratory illness caused by the virus, have been sent
home with a pulse oximeter to track their oxygen levels. A doctor or
nurse practitioner follows up with them via video conference.
“Some of these patients might have been on the borderline of
admission,” Dr. Rahul Sharma, who is overseeing the program as the chief
of emergency medicine at Presbyterian’s Weill Cornell Medical Center,
said in an interview.
An oximeter is a small electronic device that clips onto a fingertip
to indirectly measure the oxygen saturation of a patient’s blood. In
severe COVID-19 cases, the virus can block up the lungs, hindering their
ability to pass oxygen from the air into the bloodstream. While most
who contract the virus recover, it has killed at least 4,900 people in
the city, according to a Reuters tally.
Some of the NewYork-Presbyterian patients are also being sent home
with a 30lb (14 kg) portable oxygen concentrating machine which sends
oxygen-rich air through a nasal cannula, a two-pronged tube inserted
into the nostrils.
The patient is asked to log their oximeter readings to share with a
doctor or nurse practitioner at 12-hour and 24-hour consultations. The
patient may be re-admitted to the hospital if they take a turn for the
worse.
No patient in the program is known to have died at home as of
Wednesday, but about 15 percent were asked to return to hospital to be
admitted for inpatient care, a hospital spokeswoman said.
At least two other hospital systems outside of New York unveiled
similar new programs using oximeters in late March. Doctors at other
hospitals said Presbyterian’s approach could have benefits for patients
with a disease about which they still have much to learn.
“There’s no guarantees in either direction, there are risks to
hospitalization and there are risks with sending people home,” Dr. Laura
Burke, an assistant professor of emergency medicine at Harvard Medical
School, said in an interview.
Doctors have noticed there can be a worrisome lag in symptoms among
some COVID-19 patients, with oxygen saturation dropping for some time
before a patient is aware of breathing problems.
For patients that turn up at an emergency department with other
COVID-19 symptoms, giving a pulse oximeter to use at home could be one
way to “err on the side of safety,” Burke said.
https://www.reuters.com/article/us-health-coronavirus-usa-home/new-york-hospital-sends-some-borderline-covid-19-patients-home-with-oxygen-monitors-idUSKCN21Q3F0
