What criteria should I use to determine if a patient with COVID-19 requires hospital referral?

Criteria for hospital referral in patients with COVID-19 include:

• If the patient has hypoxia (reduced oxygen saturation levels) causing breathlessness, consider hospital admission; urgent admission is indicated if hypoxia is severe or the patient is severely ill.
• If hypoxia is moderate and the patient is not severely ill, arrange hospital assessment with urgency based on clinical judgement.
• Suspected complications of COVID-19 warrant hospital admission or specialist referral depending on clinical judgement.
• Patients at highest risk of becoming seriously ill (e.g., immunocompromised, elderly) should be considered for hospital referral if symptoms worsen or do not improve, especially if antibody or antiviral treatments may be indicated.
• In children, signs such as severe respiratory distress, apnoea, central cyanosis, or persistent oxygen saturation below 92% on air require urgent hospital referral.
• Clinical judgement should also consider severity scores (e.g., CRB65 for pneumonia) and other risk factors such as comorbidities, age, and clinical signs of severe illness.

Patients not meeting these criteria are generally advised to manage symptoms at home with appropriate advice and monitoring, unless deterioration occurs.

References: NICE CKS, NICE CKS, NICE NG9, NICE CG191