Remote Patient Monitoring Process Improvement

Abstract

Background: Overnight oximetry studies along with pulmonary function tests are used to determine the need for nocturnal noninvasive ventilation needs for the ALS patient population. As an ALS research center, many patients travel great distances to attend our ALS clinic. Overnight oximetry studies are usually performed the night before the quarterly ALS visit. During the COVID-19 pandemic many visits were performed virtually. This led our team to explore alternatives to our traditional testing methods. We needed to be able to provide overnight oximetry tests remotely. We found local DME companies to be inconsistent with services provided.

Methods: A multidisciplinary team reviewed our institutional overnight oximetry study process for our ALS patient population. Currently, many of our ALS patients are performing overnight oximetry studies the night before their scheduled quarterly ALS clinic appointment. Patients pick up the overnight oximeter, perform the overnight test, and then drop off the oximeter prior to their appointment. During the COVID-19 pandemic many visits were done virtually, leaving us many times with no overnight oximetry study. We sought to investigate ways to improve this process. We developed a process whereby portable overnight oximeters are mailed to ALS patients (one week) prior to their scheduled quarterly multidisciplinary appointment. If patients were scheduled for a virtual visit, a Fed-Ex return label was included. If they were scheduled for a face-to-face visit, the oximeters were downloaded during their appointment. A six question Likert type survey was developed as tool to measure things like patient satisfaction, test process, quality of sleep, and patient convenience. Patients filled out surveys of the overnight oximetry process pre and post implementation.

Results: Results show improved sleep and increased patient satisfaction. 82% of patients also rated the process as easy and 93% preferred to have the oximeter mailed to them rather than having to pick it up at our clinic.

Conclusions: As ALS progresses, making tests like overnight oximetry studies more convenient for those with ALS increases patient satisfaction. As a result of the COVID-19 pandemic, virtual visits are becoming more popular. Remote patient testing and monitoring is a must.