Even before COVID-19 put significant pressure on hospitals in Singapore, health systems such as the National University Health System were looking for ways to move care from the hospital to the home or community of a anybody. This change would help the country better manage an aging population and growing demand for hospital beds.
Singapore saw an increase in COVID-19 cases between September and December last year, leading to increased occupancy of hospital beds across the country. Many patients also expressed their preference to stay at home but due to their age, comorbidities or vaccination status, they had to be hospitalized or placed in an institution.
“The [email protected] program, which at the time cared for non-COVID-19 patients at home, saw an opportunity to provide such care to COVID-19 patients at home,” said Dr Stephanie Ko, Clinical Lead for [email protected] Home and NUHS COVID-19 Virtual Ward, and Consultant, Division of Advanced Internal Medicine, Department of Medicine, National University Hospital (NUH).
“It has also increased hospital bed capacity by extending the hospital ward into the home through a ‘virtual ward’.”
“Teleconsultation is conducted through audio or video calls to patients and/or their family members by our care team. We speak with them to address their concerns and also conduct a virtual clinical examination, which may include A sit-to-stand test involves patients measuring their oxygen levels, doing a minute of exercise while going from a sitting to standing position several times, and measuring their oxygen level again. significantly, we might be more worried about COVID-19 affecting a patient’s lungs,” Dr. Ko explained.
Patients’ vital signs are also monitored to spot early signs of deterioration. Those who have mobile devices and can use online forms are registered with a vital signs chatbot that was co-developed with health technology company BotMD. The chatbot reminds patients to enter their vital signs three times a day.
Patients who do not have mobile devices or who cannot use online forms are equipped with the Biovitals [email protected] solution from Biofourmis; a suite of connected health devices.
“Thermometer, blood pressure and oximeters are connected via Bluetooth to a tablet, which transmits the readings to our dashboard without the patients having to enter them. The tablet is also used as a teleconsultation device with a simple interface,” said Dr Ko.
“Both BotMD and Biofourmis dashboards provide the ability to send push alerts to our healthcare team if any of the vital signs exceed predefined thresholds, so that the healthcare team can take action and follow up on patients.”
“Apart from [being able to recover] from the comfort of their own home, treatment is similar to that of a COVID-19 treatment center or hospital – our doctors and nurses make daily or alternate day visits through teleconsultation and ensure that patients regularly measure and monitor their vital signs,” added Yeo Ai Wah, Senior Clinical Nurse, Advanced Practice Nurse, CareHub, Regional Health System Office, NUHS.
The healthcare team may visit patients at home if necessary to perform blood tests, change dressings, send medications or perform other nursing procedures. They may also administer drugs intravenously to reduce the chances of high-risk COVID-19 patients developing severe pneumonia.
“The NUHS COVID-19 Virtual Service team supported patients in end-of-life care based on patient or family member requests. This allowed patients to spend time with their families during their final days.”
— Yeo Ai Wah, NUHS
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It took about two weeks for the virtual service to be set up, from when it was decided that [email protected] would be expanded to support COVID-19 patients.
“Compared to non-COVID-19 patients, we wanted to minimize physical contact as much as possible, while still providing safe patient care. We also needed to ensure that our processes were quickly scalable to adapt to the many of our processes had to be changed to accommodate this approach, including adopting the Vital Signs chatbot to capitalize on patients’ own devices, and expanding our existing partnership with our home care service provider, Speedoc,” Dr. Ko explained.
“Protocols for monitoring, educating patients and families to manage COVID-19 in the home with the use of telemonitors, escalation of cases and infection control measures have been established to minimize the need for contact physical with patients. In addition to work processes, we had to address concerns of patients and families to ensure they could cope at home,” Yeo added.
Since the implementation of the virtual service in September 2021, the health system has saved more than 3,500 bed days. Over 500 patients have been treated to date.
Other benefits have been reaped, including patient empowerment.
“[They are] learned to monitor their own vital signs, as well as what is normal and abnormal, which also increases their health literacy beyond the virtual service period,” said Dr. Ko.
“The use of both teleconsultation and push notifications for abnormal vital signs means that clinicians can monitor large numbers of patients simultaneously without having to constantly observe a dashboard. This helps physicians manage a similar or greater number of patients in their homes as they would in hospital wards.”