At Toronto General Hospital, nurse practitioner Nikki Marks knows when one of her patients needs to be called at home based on numbers that appear on her screen.
“We do have a dashboard where we can see people’s saturation,” she said, referring to their oxygen levels.
“If we see someone has a low saturation or their symptoms got much worse, we can call them and check in.”
Virtual care or remote monitoring isn’t new to University Health Network or GTA hospitals — but it has expanded exponentially over the last year during the pandemic.
As ICU numbers steadily rise, remote care also helps reduce occupancy in emergency rooms throughout the already-stretched health-care system during the pandemic’s third wave. The patients range from people who came through the assessment centre and tested positive with mild symptoms, to those who were very ill and received intensive care.
They are referred to the University Health Network (UHN) through an electronic tool, and given saturation monitors if needed; which clip onto the patients’ fingers and track their oxygen levels. It’s an important service because COVID-19 patients can often feel only mildly ill, and then rapidly deteriorate and even die at home due to blood oxygen levels that suddenly drop.
Marks works in a lung-transplant program and is also part of Connected COVID Care, which launched one year ago this week. It’s provided nearly 17,000 patients who tested positive for COVID-19 with remote medical support.
Hundreds more continue to be referred weekly. Marks says patients are often appreciative and say they’re feeling more at ease knowing this system is in place.
“Sometimes, the patients have been very sick and the dashboard helped us to identify them,” she said.
“So we see the numbers didn’t look good, we phoned, and realized the patient needed to get to hospital and it helped us intervene early enough.”
UHN’s data shows that more than 900 emergency department visits were avoided due to Connected COVID Care, and at least 392 inpatient days were saved. This is critical as the health-care system continues to face mounting pressure, but Marks stresses that it’s still important for patients who are experiencing serious symptoms to come to the hospital.
“Patients who are deteriorating at home and who are requiring more oxygen or oxygen levels are coming down, we still want them to come to hospital, we still want them to seek care,” she said.
She added that the education piece that goes with this program includes informing patients that symptoms like shortness of breath, chest pain, feeling light headed or faint, warrant medical attention.
Dozens of health workers, IT specialists, administrative and public health staff have been part of this process. Marks says it’s a large-scale, collaborative effort that she hasn’t seen in her 20 years working in health care, and she says it’s only going to improve from here.
“There are a number of researchers looking at different ways we can continue to support people at home.”
Marks says she continues to see entire families infected with the virus.
“We’re offering as much emotional support too, on top of physical care.”
Improving virtual care
Dr. Tasleem Nimjee is an emergency room physician at Humber River Hospital and the physician lead for the hospital’s COVID response. She’s also the director of medical innovation.
Nimjee says remote care is happening in similar ways there, and more than it ever has before. She says the hospital is using an online platform it’s already utilizing for mental health programs and surgical transitions, and looking into how it can be used to monitor COVID-19 patients recovering at home.
“It’s something that I think has really taken off during the pandemic,” she said, adding that health-care teams are learning what it’s like to provide care “at a distance.”
But Nimjee also sees ways this type of care can grow to serve people in their community even more effectively, noting residents in their area have a very diverse background, many don’t speak English and many don’t have digital literacy.
Using vaccine clinics as an example, she says as soon as the hospital introduced walk-ins as opposed to going through an online process, Humber River saw more people from a different section of the population. She said that demonstrated that there’s still work to be done.
“So, a lot of the learning is, ‘How do we actually support remote monitoring without driving patients toward technology that isn’t patient friendly?'” she said. She added she’s optimistic about how this type of care will advance in the future.
“I think you’ll see a huge amount of work on this and a continued momentum when we’re on the other side of this, post pandemic.”