Many COVID-19 patients can be managed at home, with daily calls to assess their well being.
If using a sats monitor, a SpO2 of >= 95% is considered mild disease.
Refer for Hospital assessment if SpO2 < 92%
Give Nasal Prong O2 during transfer to keep sats >90%
If no sats monitor, video calls can provide visual information, diagnostic clues, and therapeutic presence.
Video may be appropriate for:
- sicker patients
- those with comorbidities
- those whose social circumstances have a bearing on the illness
- those who are very anxious
- patients who are hard of hearing may prefer video to telephone
Remote assessment of breathlessness:
There are no validated tests for the remote assessment of breathlessness in an acute primary care setting. These questions are recommended:
1. Ask the patient to describe the problem with their breathing in their own words, and assess the ease and comfort of their speech. Ask open ended questions and listen to whether the patient can complete their sentences: “How is your breathing today?”
2. Align with the NHS 111 symptom checker, which asks three questions:
“Are you so breathless that you are unable to speak more than a few words?”
"Are you breathing harder or faster than usual when doing nothing at all?”
“Are you so ill that you've stopped doing all of your usual daily activities?”
3. Focus on change
A clear story of deterioration is more important than whether the patient currently feels short of breath.
Ask questions such as:
“Is your breathing faster, slower, or the same as normal?”
“What could you do yesterday that you can’t do today?”
“What makes you breathless now that didn’t make you breathless yesterday?”
4. Interpret the breathlessness in the context of the wider history and physical signs. For example, a new, audible wheeze and a verbal report of blueness of the lips in a breathless patient are concerning.
There is no evidence that attempts to measure a patient’s respiratory rate over the phone would give an accurate reading, and experts do not use such tests.
It is possible, however, to measure the respiratory rate via a good video connection. More generally, video may allow a more detailed assessment and prevent the need for an in-person visit.
Source: British Medical Journal. Covid-19: a remote assessment in primary care (Accessed 14 April 2020)
MRC dyspnoea score
Roth score (which times how long it takes for a patient to take a breath while speaking or counting) on the grounds that it has not been validated in the acute setting