Monitoring

Regularly monitor the following in hospitalised patients to facilitate early recognition of deterioration and monitor for complications:[2][922]

  • Vital signs (temperature, respiratory rate, heart rate, blood pressure, oxygen saturation)

  • Haematological and biochemistry parameters

  • Coagulation parameters (D-dimer, fibrinogen, platelet count, prothrombin time)

  • ECG

  • Chest imaging

  • Signs and symptoms of venous or arterial thromboembolism.

Medical early warning scores

  • Utilise medical early warning scores that facilitate early recognition and escalation of treatment of deteriorating patients (e.g., National Early Warning Score 2 [NEWS2], Paediatric Early Warning Signs [PEWS]) where possible.[2]

  • There are no data on the value of using these scores in patients with COVID-19 in the primary care setting.[959] 

Pregnant women

  • Monitor vital signs three to four times daily and fetal heart rate in pregnant women with confirmed infection who are symptomatic and admitted to hospital. Perform fetal growth ultrasounds and Doppler assessments to monitor for potential intrauterine growth restriction in pregnant women with confirmed infection who are asymptomatic.[583] Perform fetal growth ultrasound 14 days after resolution of symptoms.[585]

Post-discharge follow-up

  • Patients who are discharged from hospital may have immediate and longer-term health needs including physical (e.g., pulmonary and cardiac rehabilitation, tracheostomy wounds, pressure ulcers, dysphagia, chronic cough, fatigue, neuropathy, muscular weakness, long-term risk of chronic respiratory disorders), psychological and neuropsychological (e.g., delirium, cognitive impairment, post-traumatic stress disorder, anxiety, depression), and social (e.g., impaired activities of daily living).[960]

  • Guidelines for the respiratory follow-up of patients with COVID-19 pneumonia have been published. Follow-up algorithms depend on the severity of pneumonia, and may include clinical consultation and review (face-to-face or telephone) by a doctor or nurse, chest imaging, pulmonary function tests, echocardiogram, sputum sampling, walk test, and assessment of oxygen saturation.[961]

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