Novel Use of Home Pulse Oximetry Monitoring in COVID‐19 Patients Discharged From the Emergency Department Identifies Need for Hospitalization

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>Our objective was to evaluate patient‐reported oxygen saturation (SpO<jats:sub>2</jats:sub>) using pulse oximetry as a home monitoring tool for patients with initially nonsevere COVID‐19 to identify need for hospitalization.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients were enrolled at the emergency department (ED) and outpatient testing centers. Each patient was given a home pulse oximeter and instructed to record their SpO<jats:sub>2</jats:sub> every 8 hours. Patients were instructed to return to the ED for sustained home SpO<jats:sub>2</jats:sub> < 92% or if they felt they needed emergent medical attention. Relative risk was used to assess the relation between hospitalization and home SpO<jats:sub>2</jats:sub> < 92% in COVID‐19–positive patients.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We enrolled 209 patients with suspected COVID‐19, of whom 77 patients tested positive for COVID‐19 and were included. Subsequent hospitalization occurred in 22 of 77 (29%) patients. Resting home SpO<jats:sub>2</jats:sub> < 92% was associated with an increased likelihood of hospitalization compared to SpO<jats:sub>2</jats:sub> ≥ 92% (relative risk = 7.0, 95% confidence interval = 3.4 to 14.5, p < 0.0001). Home SpO<jats:sub>2</jats:sub> < 92% was also associated with increased risk of intensive care unit admission, acute respiratory distress syndrome, and septic shock. In our cohort, 50% of patients who ended up hospitalized only returned to the ED for incidental finding of low home SpO<jats:sub>2</jats:sub> without worsening of symptoms. One‐third (33%) of nonhospitalized patients stated that they would have returned to the ED if they did not have a pulse oximeter to reassure them at home.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This study found that home pulse oximetry monitoring identifies need for hospitalization in initially nonsevere COVID‐19 patients when a cutoff of SpO<jats:sub>2</jats:sub> 92% is used. Half of patients who ended up hospitalized had SpO<jats:sub>2</jats:sub> < 92% without worsening symptoms. Home SpO<jats:sub>2</jats:sub> monitoring also reduces unnecessary ED revisits.</jats:p></jats:sec>