Dr. Blayke Gibson works at the front lines of the COVID pandemic in the emergency department at UAB Hospital, where she sees some of the state’s sickest patients.
But as beds fill up at UAB and across the state, Gibson and her colleagues are increasingly sending some of them home as part of a program designed to treat borderline cases outside of the hospital. UAB has purchased inexpensive pulse oximeters that can be sent home with patients and allow them to monitor their oxygen levels remotely, saving hospital beds for patients who are sicker. Doctors follow up by phone or video call within 24 hours and frequently after that, to make sure the patient isn’t getting any worse.
Gibson said the program was modeled on one developed at Weill Cornell Medicine in the spring, when hospitals in New York struggled with an influx of COVID patients. Gibson said she and her colleagues select patients at low to moderate risk and the resources to follow up with doctor’s visits.
“What we do is send them home with a pulse oximeter,” Gibson said. “We teach them how to use the devices when they leave. We teach them about an ambulatory saturation test. We give them protocols for when they may need to return to the ED.”
The pandemic is forcing UAB and other medical providers to make the best use of hospital resources. Patients who don’t require mechanical ventilation may not benefit much from being admitted. Treatments such as remdesivir that are administered to hospitalized patients haven’t been shown to reduce mortality rates.
A pulse oximeter can identify patients who aren’t getting enough oxygen and need hospital treatment. Robin Scott, a nurse practitioner in Marshall County, has treated several patients at home with pulse oximeters and, in some cases, portable oxygen.
Before COVID, she said she would always send patients to the hospital when their oxygen levels dropped below 90. Now she has learned to manage some of her patients at home with portable oxygen. She started ordering oxygen and breathing treatments for some patients who refused to go to the hospital.
“They’re terrified,” Scott said. “They are absolutely terrified of this virus and being ventilated and dying and this is all very scary for them.”
Scott’s staff members keep close tabs on COVID patients.
“I have staff that if somebody that is very ill, they call them every single day,” Scott said. “For the most part, we have had tremendous success keeping them out of the hospital.”
Leslie Wright and her husband Mark Hopper both became sick with COVID in November. Scott coached Wright through her illness at home, checking in frequently and prescribing medication to treat different symptoms.
As Wright recovered, her husband became sicker. Scott brought him into her clinic for IV fluids and breathing treatments. She sent an x-ray technician to the home with a portable machine to scan his chest. His oxygen levels continued to drop and Scott determined he had pneumonia in both lungs.
“I came in and said, ‘We need to go to the hospital,’ and he said, ‘Who are you?’” Wright said.
Hopper was in the hospital for five days, where he received remdesivir and made a full recovery.
“The one thing about the doctor having constant contact with us was that she knew what to do,” Wright said. “I probably wasn’t thinking as clearly as I would have been normally. Just having that support made us feel more supported.”
Dr. David Thrasher of Montgomery Pulmonary Consultants has treated patients both in and out of the hospital. And he is pushing for better treatments early in the illness to prevent hospitalizations. Although many patients recover without medication, he believes that treating more people earlier in the illness could prevent hospitalization and death.
“As I have said for many months, I believe we should treat these patients early rather than later and do everything we can to keep them out of the hospital,” Thrasher said. “Once they’re in the hospital our options are extremely limited.”
Thrasher treated the first patient in Alabama admitted to the hospital with COVID-19. In the months since, he has tweaked his treatment regimen to improve outcomes. He is hopeful monoclonal antibody treatments can keep even more patients at home, since they can be administered outside the hospital.
Many patients he now monitors at home with portable oxygen and pulse oximeters would have been admitted to the hospital over the summer. Thrasher said it is critical to closely monitor patients for signs they aren’t getting enough oxygen.
“I have gotten several patients oxygen for home use rather than put them in the hospital,” Thrasher said. “This has to be monitored very carefully and I ask my patients to check their oximetry at least three times a day and report to me if their saturations fall. This is labor intensive, but I do believe it is paying dividends and we are keeping more people out of the hospital.”
Patients struggling for breath may still need hospital treatment, Gibson said. As doctors learn more about the virus, they have gotten better at identifying patients in the most danger.
“A lot of this is new,” Gibson said. “We are learning as we go and trying to be sure we utilize the lessons from earlier in the pandemic to use our resources in the most responsible way.”