Dr. Blake Gibson works in the emergency department at the UAP Hospital in the front line of Govt Infection, where he sees some sick patients in the state.
But as beds fill up in the UAP and across the state, Gibson and his colleagues are increasingly sending some of them home as part of a program designed to treat borderline cases outside the hospital. UAP has purchased inexpensive pulse oximeters that can be sent home with patients and allows them to remotely monitor their oxygen levels, saving hospital beds for sick patients. Doctors follow up with a phone or video call within 24 hours, after which often, make sure the patient is not getting worse.
Gibson said the plan was designed in the spring when hospitals in New York struggled with the influx of COVID patients. Gibson said he and his colleagues would select patients with low-risk to moderate risk and select evidence to follow physician visits.
“What we do is send them home with a pulse oximeter,” Gibson said. “We teach them how to use devices when they go out. We teach them about ambulatory concentration testing. We provide them with protocols when they need to return to ED. ”
Infection forces UAB and other medical providers to make better use of hospital resources. Patients who do not require mechanical ventilation will not benefit much as they are admitted. Treatments such as Remdecivir administered to hospitalized patients have not been shown to reduce mortality.
A pulse oximeter can identify patients who are not getting enough oxygen and require hospital treatment. Robin Scott, a nursing practitioner in Marshall County, has treated many patients with pulse oximeters and, in some cases, with little oxygen.
Prior to COVID, he said he would always send patients to the hospital when their oxygen levels dropped below 90. Now he has learned to manage some of his patients at home with little oxygen. He began ordering oxygen and respiratory treatments for some patients who refused to go to the hospital.
“They were scared,” Scott said. “They’re totally scared about this virus, dying of suffocation, which is so scary for them.”
Scott’s staff has close tabs on COVID patients.
“I have staff, and if someone is very sick, they call them every day,” Scott said. “For the most part, we have had tremendous success in getting them out of the hospital.”
Leslie Wright and her husband Mark Hopper both fell ill with COVID in November. Scott trained Wright at home with the disease, frequently checking and prescribing medications to treat different symptoms.
As soon as Wright recovered, her husband fell ill. Scott brought him to his clinic for IV fluids and respiratory treatments. She sent an X-ray technician home with a small machine to scan her chest. His oxygen level continued to drop and Scott determined he had pneumonia in both lungs.
“I came in and said, ‘We have to go to the hospital,’ and he said, ‘Who are you?’ ‘He said that.
Hopper was hospitalized for five days, where he received remedivir and made a complete recovery.
“One thing about the doctor being in constant contact with us is that she knows what to do,” Wright said. “I do not think as clearly as I used to. Having that support made us more supportive.”
Dr. David Thrasher of Montgomery Lung Consultants has treated patients in and out of the hospital. And he offers the best treatments at the onset of the disease to prevent hospitalization. Although many patients recover without medication, he believes treating more people before the disease will prevent hospitalization and death.
“As I have said for months, I believe these patients should be treated later and then we should do everything we can to get them out of the hospital,” Thresher said. “Our options are very limited once they are hospitalized.”
The first patient in Alabama was hospitalized with Trosher Covit-19. In the months that followed, he modified his treatment to improve the results. He believes monoclonal antibody treatments can keep more patients at home because they can be administered out of the hospital.
Many of the patients he now monitors at home with portable oxygen and pulse oximeters would have been admitted to the hospital in the summer. Thresher said it is important to carefully monitor the symptoms of patients not getting enough oxygen.
“I get more oxygen for home use than I do for many patients in the hospital,” Thresher said. “It needs to be monitored very carefully, and I’m asking my patients to check their oximetry at least three times a day and report it to me if their concentration drops. It’s laborious, but I believe it pays dividends.
Patients struggling for respiration may still need hospital treatment, Gibson said. As doctors learned more about the virus, they became better at identifying high-risk patients.
“It’s a lot new,” Gibson said. “We are learning as we go, and we are trying to ensure that previous lessons of epidemics are used in a very responsible way with our resources.”