Novel Use of Home Pulse Oximetry Monitoring in COVID‐19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization

Abstract

Abstract Objectives Our objective was to evaluate patient‐reported oxygen saturation (SpO 2 ) using pulse oximetry as a home monitoring tool for patients with initially nonsevere COVID‐19 to identify need for hospitalization. Methods Patients were enrolled at the emergency department (ED) and outpatient testing centers. Each patient was given a home pulse oximeter and instructed to record their SpO 2 every 8 hours. Patients were instructed to return to the ED for sustained home SpO 2 < 92% or if they felt they needed emergent medical attention. Relative risk was used to assess the relation between hospitalization and home SpO 2 < 92% in COVID‐19–positive patients. Results We enrolled 209 patients with suspected COVID‐19, of whom 77 patients tested positive for COVID‐19 and were included. Subsequent hospitalization occurred in 22 of 77 (29%) patients. Resting home SpO 2 < 92% was associated with an increased likelihood of hospitalization compared to SpO 2 ≥ 92% (relative risk = 7.0, 95% confidence interval = 3.4 to 14.5, p < 0.0001). Home SpO 2 < 92% was also associated with increased risk of intensive care unit admission, acute respiratory distress syndrome, and septic shock. In our cohort, 50% of patients who ended up hospitalized only returned to the ED for incidental finding of low home SpO 2 without worsening of symptoms. One‐third (33%) of nonhospitalized patients stated that they would have returned to the ED if they did not have a pulse oximeter to reassure them at home. Conclusions This study found that home pulse oximetry monitoring identifies need for hospitalization in initially nonsevere COVID‐19 patients when a cutoff of SpO 2 92% is used. Half of patients who ended up hospitalized had SpO 2 < 92% without worsening symptoms. Home SpO 2 monitoring also reduces unnecessary ED revisits.

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