Dr .. Black Gibson works on the front lines of the covid epidemic in the emergency department at UAB Hospital, where he sees some of the most patients in the state.
But with beds being filled at UAB 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. UAB has purchased inexpensive pulse oximeters that can be sent home with patients and allow them to remotely monitor their oxygen levels, to save hospital beds for patients who are sick. Doctors call frequently within and after 24 hours by phone or video call to make sure the patient has no discomfort.
Gibson said the program was based on the development in Will Cornell Medicine in the spring, when there was an influx of Kovid patients in New York hospitals. Gibbs said she and her colleagues select patients with low to moderate risk and are a tool for visiting visits.
Gibson said, “What we do is send home with a pulse oximeter. “We teach them how to use the devices when they come out. We teach them about ambulatory saturation testing. We give them protocol when they need to return to the ED. ”
The epidemic is forcing UAB and other medical providers to make the best use of hospital resources. Patients who do not need mechanical ventilation may not benefit much from admission. Treatments such as remedivisor given to hospitalized patients have not been shown to reduce mortality.
The pulse oximeter can identify patients who do not get enough oxygen and need hospital treatment. Robin Scott, a nurse practitioner in Marshall County, has treated many patients at home with pulse oximeters and, in some cases, portable oxygen.
Before Kovid, she said he always sent patients to the hospital when their oxygen levels fell below 90. Now she has learned to manage some of her patients at home with portable oxygen. He started ordering oxygen and respiratory treatment for some patients who refused to go to the hospital.
“They’re terrified,” Scott said. “They are terrified of the virus and they are dying and it is very scary for them.”
Scott’s staff keeps a close eye on COVID patients.
“I have staff that if someone is very sick, they call them every day,” Scott said. “Mostly, we’ve had tremendous success keeping them out of the hospital.”
Leslie Wright and her husband Mark Hopp both fell ill with covid in November. Scott taught Te Wright at home through his illness, frequently examining and prescribing medicine to treat various symptoms.
As soon as Wright recovered, her husband became ill. Scott brought her to her clinic for IV fluids and respiratory treatment. He sent an X-ray technician 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.
Hop was in the hospital for five days, where he received remedivisor and a full recovery.
“One of the things about the doctor’s constant contact with us was that she knew what to do,” Wright said. “I probably didn’t think as clearly as I normally would. Just that support gave us more support. “
Dr. David of Montgomery Pulmonary Consultants. David Thrasher treated patients both in and out of the hospital. And pushing for better treatment early in the illness so they can prevent hospitalization. Although many patients recover without taking medication, they believe that treating more people earlier in the illness can prevent hospitalization and death.
“As I have said for many months, I believe we should treat these patients sooner than later and we should do as much as possible to keep them away from the hospital,” Thresher said. “Our options are very limited once they come to the hospital.”
Thrasher treated Alabama’s first patient hospitalized in Civil-19. In the months that followed, he tweeted his treatment method to improve the outcome. He hopes monoclonal antibody therapy can keep more patients at home, as they are administered outside the hospital.
Many patients now monitor it at home with portable oxygen and pulse oximeters, they were hospitalized during the summer. Thresher said it was important for patients to be closely monitored for signs that they were not getting enough oxygen.
“I’ve gotten many patients oxygen for home use instead of putting them in the hospital,” Thresher said. “This has to be monitored very carefully and I tell my patients to check their oximetry at least three times a day and let me know if their satisfaction decreases. This labor is intensive, but I believe it pays dividends and we keep more people out of the hospital. “
Gibson said patients struggling to breathe may still need hospital treatment. As doctors learn more about the virus, they have been able to better identify the most at-risk patients.
“This is a lot of new stuff,” Gibbs said. “We are learning as we go along and trying to make sure we use the pre-epidemic lessons to use our resources very responsibly.”
