Royal Surrey’s Innovative Virtual Clinic a Safety Net For Covid Patients Sent Home

Published on: 23 Apr, 2021
Updated on: 23 Apr, 2021

Joseph Joby, a patient of the Covid virtual clinic.

Care home nurse Joseph Joby has thanked the Royal Surrey for the support from their virtual Covid clinic after his bout with the virus left him breathless and fearful.

Mr Joby, 36, caught Covid in January from a care home resident. During his month-long illness, he felt so ill and breathless he was admitted to the Emergency Department (ED) for assessment.

After discharge, he joined the hundreds of people cared for by the innovative virtual Covid clinic, organised by the ED team. Their efforts have allowed Covid patients to stay safe but connected to vital help and monitoring.

Dr Hannily Cooke

Dr Hannily Cooke, an emergency medicine trainee registrar and Dr Carlo Arrigo, clinical ED director, set up the clinic at the beginning of the pandemic, helping 70 patients in two months at the height of the crisis.

Supported by the ED team and the Ambulatory Emergency Care Unit (AECU) nursing team, one of the clinic’s main aims is early detection of patients affected by deteriorating oxygen levels in blood, a dangerous complication of Covid.

So they provide discharged Covid patients with an oximeter, which measures oxygen levels in blood, and can pick up a potentially fatal drop sometimes “symptomless”, so difficult to spot.

Dr Cooke said: “Some patients develop ‘silent hypoxia’ where the level of oxygen in their blood drops to a dangerously low level but the patient shows no obvious signs of being unwell, such as breathlessness or pain.

“This may mean a patient can be unaware of the danger and might delay treatment until they are critically ill and in need of urgent medical help.”

When Mr Joby, a trained nurse, was monitoring his saturation levels, he said at one point he called for an ambulance when the blood oxygen readout had dropped to 89 per cent (a normal readout would be 95 per cent).

The ambulance crew arrived quickly, checked him and gave welcome reassurance and advice, which meant he was able to stay at home knowing he was not in danger but could get back in touch if his condition worsened.

In his case, the drop in oxygen saturation levels was accompanied by worsening symptoms, but he knew this was not always the case. He said having the oximeter and the contact with the virtual clinic provided an essential layer of security, an extra safety net.

Dr Cooke said: “The clinic has been extremely well-received and the patients are universally grateful for the support.

“After leaving hospital, Covid patients are often feeling very scared and isolated and unsure of how to get help. They’re trying to hold their lives together with financial and other pressures, all while feeling the worst they’ve ever felt.

“ED doctors working in the AECU phone patients on day two and day five after they are discharged from the ED to check their oxygen saturations and assess how the patient is managing with Covid at home.”

Mr Joby said: “The follow-up phone calls from the Covid virtual clinic doctors were really helpful. They were so kind and supportive. It was like having brotherly support and reassurance and I felt very grateful. In fact, I can’t thank them enough for that support.

“It took me a long time to recover and there were some days when I felt I had no hope of getting better and that I was actually going backwards, but the support and encouragement from the clinic made a huge difference.

“At a very emotionally worrying time, it offered a reassuring lifeline of information and advice. I think knowing the clinic doctors were in contact made it less of a worry for my family too; they knew I had that back-up.”

Dr Arrigo said: “Virtual clinics and remote monitoring are buzzwords in health settings now and likely to become permanent features relevant in many different forms, definitely not just of help during a pandemic.

“I’m very proud of our quick-thinking teams and of how the Trust frequently leads the way with new and innovative ways of improving patient safety.”