Primary Care Network: Pulse oximetry supporting general practice

Pulse oximeters are being distributed across the country to help support the COVID-19 pandemic response. But how do they work and why is pulse oximetry becoming such a crucial part of how general practice is delivered during a pandemic?

Pulse oximeters can identify ‘silent hypoxia’, where oxygen levels are dangerously low but a patient does not feel out of breath. This means people can get the treatment and support they need more quickly.

The simple device works by fitting to the end of your middle or index finger. By transmitting light through a finger, it can identify whether oxygen in the blood is at normal levels. These levels are then recorded by patients or carers either on paper or via an app, with regular check ins from health and care teams.

You can find out more about how pulse oximetry works by watching this video.

Harleston Medical Practice in Norfolk first decided to purchase 20 pulse oximeters and 20 thermoscan thermometers back at the start of the pandemic in March 2020, to use within some simple home observation and screening kits. A pulse oximeter, thermoscan, a couple of probe covers and a simple instruction leaflet and record sheet were placed into a disposable zip-lock bag and given to patients presenting with COVID-19 symptoms. The patient could either nominate a healthy representative to collect a kit, or the practices’ own social prescribers delivered them straight to the patient’s front door.

The practice then recorded which patients were being provided with a kit, so that they could easily keep track of where they were and when they needed to be returned.

Once the patient has submitted their readings to the practice, the receptionist is able to update that patient’s individual record with a ‘NEWS score’ to give an early triage of the results and they are transcribed into the patient notes with the clinician being informed of the result. The kits are then thoroughly cleaned and disinfected, ready to be re-used.

To date the kits have been used 504 times, with the highest number given to patients between September and December 2020, as cases increased over the winter months.

So how have the kits supported general practice? They have allowed the practice to make informed decisions, in many cases, without seeing the patient face to face, reducing risk of transmission to staff and other patients and reducing the number of face to face consultations required and in turn the amount of PPE used.

The kits have identified positive COVID-19 cases that needed to be admitted to hospital, including a direct admission to an ITU. The practice has also triaged positive cases that would need to be seen face to face using the observation packs. The kits have resulted in other clinical admissions, including sepsis admissions, as well as cardiac cases, as a result of the patient using the home monitoring equipment.

More recently, other remote monitoring equipment has been added to kits where this would be useful. This has included peak flow meters for asthmatics and urine bottles for assessment. The practice has also begun to include distribution of COVID-19 viral swab kits dependent upon clinical history, which has already led to diagnosing more positive COVID-19 cases.

To date in January 2021 the practice has issued 45 observation packs. The packs have led to the diagnosis of many positive coronavirus cases, as well as a non-COVID-19 diagnosis requiring admission with pulmonary embolism.

Practice Manager Maria Flood commented that social prescribers within their local primary care network (PCN) have been ‘invaluable in the process, delivering to housebound and/or isolating patients’ who would have no other way of safely collecting their kits.

Maria summarised that what may seem like a ‘really simple idea’ has ‘worked incredibly well’ for her practice and would encourage others who are able to create similar kits to do the same.

Pulse oximeters, along with other remote monitoring equipment, can be used in general practice in the following ways;

  • To augment information gained through telephone or video consultation
  • To help inform whether a patient needs a face to face appointment with a clinical professional, and if so, the level of PPE required
  • To assess whether a patient should be seen at a hot or cold clinic
  • To assess sepsis risk
  • To ascertain whether admission is required
  • To assess whether a patient has deteriorated
  • During end of life care
  • To enable nursing home, care home and residential settings to provide observations when seeking GP advice

Pulse oximetry is now being rolled out at pace across the country, with Integrated Care Systems (ICSs) being required to establish COVID virtual wards (CVWs) within secondary care, allowing for earlier and safer discharge of COVID-19 inpatients. Patients are seen virtually by hospital clinicians, using self-monitoring equipment in their own homes. CVWs have been proven to reduce admissions and length of stay of patients requiring a higher level of clinical support than is available through the COVID Oximetry @home model.