We hear more from Adrian Flowerday about why Virtual Wards are now very much on the national agenda.
Adrian says: ‘It’s fantastic that the government and the NHS are having a real focus on rolling out Virtual Wards as a way to reduce the pressures on hospital beds and reduce waiting lists. We’ve been providing remote monitoring at Docobo for over 21 years, and during the pandemic, we were able to support the NHS with their remote monitoring and virtual ward requirements as everyone got used to new ways of working. Our whole driving force at Docobo is keeping people out of hospital who don’t need to be there and monitoring people at home, where many people prefer to be cared for. The new NHS Operational plan for 2023/24 priorities and operational planning guidance published in late December 2022 understandably has a huge focus on implementing virtual wards in order to free up hospital beds. In fact, the document refers to Virtual Wards as ‘evidence based actions’ that will help NHS deliver objectives. There are some ambitious targets set for the roll out of virtual wards – otherwise known as ‘hospitals at home’ – in 2023, including the target that the use of virtual wards should be increased to 80% by the end of September 2023.
The NHSE definitions of Virtual Wards are ones which are specifically focussed on where patients are under the care of an acute consultant or clinical team, but monitored and cared for in their own homes. This can be for patients who can be discharged home earlier with the support of remote patient monitoring (termed ‘Step Down’), or for patients whose emergency admission can be avoided by the support of remote patient monitoring (termed ’Step Up’). Patients are typically on a Virtual Ward for around a week, and Virtual Wards aim to help get patients out of hospital as soon as safely possible and, essentially, free up hospital beds.
Virtual Wards mean that patients are still under the care of a hospital, but able to stay in their own homes. Whilst on the Virtual Ward, patients regularly check their vital signs (such as blood pressure, oxygen, respiration rate, etc) and symptoms. For some patients, vital signs data is collected continuously via a wearable device. Data is collected and fed back via a medical device or via apps running on Android and iOS platforms. This intense monitoring picks up any deterioration in patients’ conditions, as these are flagged up, and appropriate medical care can be provided quickly and efficiently. It also means that when the patient’s condition improves, they can be ‘virtually’ discharged back to the primary care team, where they can continue to be monitored or discharged as appropriate.
Can you tell us about what trusts need in order to ensure Virtual Wards are successful?
Although the concept of Virtual Wards – or ‘hospitals at home’ is relatively simple, the logistics of carrying out remote monitoring, can be more complex, as this involves coordinating different specialists, and liaising with others that may be involved, for example: GPs, community care teams, district nurses, mental health and social care.
For Virtual Wards to work, NHS organisations need:
· Access to remote monitoring equipment to cover different care settings and conditions – oximeters, blood pressure monitors, glucometers, etc.
· Reliable internet connections to connect to those devices.
· A communication platform that allows interaction between the patient and the clinicians, ensuring that they feel connected and cared for, despite being at home.
· A good remote patient monitoring platform to safely and securely capture and display information and ensure that it is visible to all of the professionals involved in that person’s care via their EPR
· Clear operating procedures, Information Governance and referral criteria
· A robust equipment logistics operation that can cope with patients being continuously discharged after 10-15 days, collecting and sanitising the equipment and retuning it to stock locations.
Can you give us some examples of trusts that are doing this well?
I can think of many organisations who are using the Docobo solution to reap the benefits of Virtual Wards. We started what has now been named ‘Virtual Wards’ back in 2008, saw a rapid expansion in 2020 as Covid hit, and currently have many Virtual Wards running across the country. Merseyside is a region that immediately springs to mind as they have run multiple remote monitoring initiatives, which have seen huge value. In 2021, for example, patients in Merseyside were cared for on their own Covid Virtual Ward run by a collaboration of Mersey Care NHS Foundation Trust and Liverpool University Hospitals NHS Foundation Trust (LUHFT). Consultants undertook daily virtual ward rounds assessing patient observations, which included blood oxygen levels, blood sugars, ketones etc. Readings were submitted by patients using a Docobo Careportal® , which is our tablet-like medical device.
According to the trusts, this helped reduce pressure on hospital beds, and with monitoring of vital signs in the community it was possible for clinicians to remotely observe patients or any clinical deterioration, with the option to review in ambulatory care as necessary.
Coventry and Warwickshire are also doing really well, as respiratory patients across the region are using remote monitoring to safely and conveniently manage their conditions at home rather than in hospital. The Chronic Obstructive Pulmonary Disease Virtual Ward at University Hospital, Coventry was launched eight months ago and has been so well recieved that it was recently extended to accept community referrals. Warwick Hospital and George Eliot in Nuneaton are now also using the same technology to help remotely monitor eligible respiratory patients, who meet certain criteria, as part of the process of moving towards Virtual Wards.
Equipment, including a mobile phone with a remote monitoring app, a thermometer, blood pressure monitor and a pulse oximeter reader are provided to those using the service. Patients are shown how to use the equipment and send readings, with conversations taking place between them and healthcare professionals on a daily basis and tailored observations and follow-ups held depending on their requirements. Patients have access to help and support should they need it at any time.
This new way of working ensures that patients continue to be under the care of the hospital consultant and form part of a Virtual Ward round where their condition and management plan is reviewed. People have fed back that it transforms the way patients are managed and has a positive impact on their quality of life.
We have had some great firsts. At Aintree in 2017, we launched an innovative Motor Neurone Disease virtual ward. At Dudley, the country’s first paediatric respiratory Virtual Ward went live. In the North West, we support a service monitoring and prioritising patients whilst they wait for cardiac surgery.
Since the NHS notice went out to mobilise Virtual Wards, we’ve worked closely with the fantastic teams across the area to mobilise our DOC@HOME platform to enable their virtual wards, and I’m really impressed how the team have worked so hard to provide this care.
What do you see as the future of Virtual Wards?
Virtual Wards, along with remote monitoring of long-term conditions in the community, are being pushed from the top down. The expansion and continued rollout of Virtual Wards is one of the top priorities across the NHS for 2023 and beyond, helping to shift care safely from busy hospitals into patients’ homes. Time will tell how long the acute Finance Directors will continue to fund it as the central pump funding is removed, so it’s vital the funding is used wisely and focussed in the places where it will make the most difference, which I personally feel is in reducing emergency admissions to a physical ward, i.e. the Step Up part.
Whilst we have seen great examples of early supported discharge – with Virtual Wards helping many people – hospitals have already made great strides over the last 20 years in reducing length of stay, with the main reason for delayed discharge typically being social care capacity. With ‘Step Up’, we can prevent admissions and all the changes to a patient’s life and independence that this can cause.
The exciting thing about Virtual Wards, is that the possibilities are endless. Whereas the focus is currently on specific pathways, there are no end of conditions that can be managed effectively from home, along with reduced physical outpatient appointments, which will improve both outcomes for patients being treated in the comfort of their own home and avoid the need for countless trips to hospitals or clinics which could be avoided using remote monitoring. This really is a glimpse into the future, where seamlessly integrated care happens from home to hospital.
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