‘Part of the solution’: how virtual NHS wards are now a reality

Harold Chugg spent much of early 2023 in a hospital bed due to worsening heart failure. During his most recent admission in June, the 75-year-old received multiple blood transfusions, causing fluid to build up in his lungs and tissues.

Normally he would have remained in hospital for days or weeks while the medical team managed his fluid retention. But Harold was offered an alternative: admission to a virtual ward where he would be closely monitored in the comfort of his own home.

Armed with a computer tablet, a Bluetooth blood pressure cuff and scales, Harold returned to his farm near Chulmleigh in north Devon and daily recorded his own symptoms and measurements, which were assessed by a specialist nurse in another part of the country. province.

“It allowed them to free up my bed for another patient who needed it more than me and saved me from having to travel a lot for voluntary follow-up,” Chugg said. He was discharged six weeks later and his condition has remained relatively stable since.

Welcome to what NHS England believes could become a mainstay of treatment for short but serious bouts of illness over the next decade. Virtual wards provide hospital-level care in people’s homes through the use of apps, wearables and daily ‘virtual ward rounds’ by medical staff, who view patient data and follow up with telephone calls or home visits if necessary.

There are already more than 10,000 such beds available across England and at least 15,000 more are available. planned. Scotland, Wales and Northern Ireland are also financing their expansion.

But while advocates argue that patients in virtual wards recover at the same rate or even faster than those treated in hospital, and that the wards’ amenities can help reduce waiting lists and costs, some worry that their rapid expansion could add additional could put pressure on patients and healthcare providers, while This distracts from the need to invest in emergency care.

“Virtual departments, if they deliver hospital-level care processes, are only part of the solution and not a silver bullet,” says Dr. Tim Cooksley, recently ex-president of the Society for Acute Medicine.

The first virtual department was trialled in Croydon, South London in 2005. A computer model identified which patients were most at risk of emergency admission in the coming year and a dedicated team of nurses, pharmacists and physiotherapists targeted them with interventions to prevent crises. and keep them at home.

“Hospital wards are a really clever invention,” says Dr Geraint Lewis, who led the Croydon pilot and is now director of public health at Microsoft. “Crucially, you have the daily routines of ward rounds, council rounds, medicine rounds and observation rounds, and then this central hub called the nurses’ station, where the different members of a multidisciplinary team discuss the patients together.

“What a virtual department does is recreate these structures, staffing levels and daily routines, with the crucial difference being that the patient is at home.”

The plan inspired similar interventions in Britain and beyond. However, it wasn’t until the Covid-19 pandemic that virtual departments really took off.

Lewis said: “During the pandemic there was pressure to try to keep patients out of hospital if possible, while the advent of technologies like Teams and Zoom opened people’s minds to how you could use technology to bridge the gap between doctors and patients. bridge. , without having to physically be in the hospital.”

Hospitals began sending some Covid patients home with pulse oximeters and data logging apps to remotely monitor their oxygen levels. The approach has since spread to other areas of medicine and is increasingly used to facilitate earlier discharge and prevent patients from being admitted in the first place.

Other remote monitoring equipment is also being developed, including home electrocardiograms to monitor heart activity, USB stethoscopes that allow doctors to listen to patients’ heart or abdominal sounds remotely, and even remote blood test.

Royal Devon NHS Trust is currently caring for around 37 patients in virtual beds, with conditions ranging from pneumonia to bacterial skin infections and kidney disease. “Each of these patients would normally be in a (hospital) bed, which is a significant percentage of our beds for people who are acutely unwell,” said the trust’s chief medical officer, Dr Adrian Harris.

“I truly believe that we are at a turning point within the NHS and that we will see more and more people being cared for virtually, through wearables and their integration with extensive electronic health records, as well as a wider scope of patients attending on virtual wards can be included.”

Royal Devon is not the only trust to embrace the technology, but Devon’s large elderly population and predominantly rural environment has accelerated its introduction because pressure on hospital beds there is so great and some patients have to travel long distances to attend outpatient appointments live.

Poppy Brooks, a heart failure specialist nurse, has a list of patients on the virtual ward, colour-coded according to the urgency with which they need to be assessed and contacted.

With up to 30 patients on the ward at any given time, these daily assessments still take a specialist nurse several hours to complete. But Brooks and her colleague Angie Tithecott believe that caring for certain heart failure patients is more efficient this way.

Tithecott said: “Historically, patients were assessed on an outpatient basis every six weeks to optimize the medications that help them live longer and improve their quality of life.” Normally this would have taken six to 12 months, assuming they have not deteriorated in the meantime, “but due to waiting times, which are increasing due to increased demand, it has taken longer to get them to optimal condition.”

In addition to improving their health, remote monitoring also helps free up clinic time and reduce waiting lists. “It means that both models of care are improving,” says Tithecott.

Some experts are concerned that the rush to switch to virtual beds is happening too quickly and could divert attention from more pressing issues within the NHS. Cooksley said: “The fundamental problem remains that demand in all contexts has exceeded healthcare capacity for a significant period.”

Dr. David Oliver, consultant in geriatrics and acute general medicine at Royal Berkshire NHS Foundation Trust, believes the money spent on expanding the virtual ward would be better spent on existing community services to support the return home of patients who no longer having to go home. in hospital, but has complex care needs.

a study published in BMJ Open last week, which assessed 318 virtual ward patients with a range of conditions at Wrightington, Wigan and Leigh University Hospitals, NHS Trust, suggested that although their initial hospital stay was shorter, they also had higher readmission rates experienced, which ultimately led to additional costs.

None of this means that virtual departments are necessarily a bad thing. “What the evidence says is that if you do it for the right people, it’s as effective as being in a hospital bed, and people like it,” Oliver said. “It also reduces the risk of exposure to hospital complications and deconditioning, and there are very good staff working in these hospitals.

“However, there is no real evidence on any scale that they will ease pressure on acute hospitals or be a silver bullet to the much wider system problems.”