Coordinating care across virtual wards

5th January 2022

Last month NHS England issued urgent guidance stating that 15% of covid patients must be treated at home by the end of the year, ahead of the expected Omicron wave.

What is a virtual ward?

A virtual ward model can be interpreted in different ways and adapted to meet the needs of the patient caseload, as well as what technology is available.

The primary aim of all virtual wards is to provide care outside of a clinical setting and avoid hospital admissions. This can be in a domestic setting, a care home or assisted living facility. In-situ care can be used to overcome mobility limitations, and increasingly to limit the spread of infections, such as MRSA and Covid-19.

NHS England has listed the benefits of ‘Virtual Ward’ approaches that have been recognised seen during the pandemic as:

  • Helping to keep people in their preferred place of care 
  • Facilitating safe and timely discharge 
  • Admission avoidance where appropriate 
  • Encouraging collaborative and Individualised patient care 
  • Improved communication between all services, people and their carers 
  • Development of new Mutual Aid Models and supporting Integrated working.

How does a virtual ward work?

Many virtual ward models are run by a multidisciplinary team, who may function as part of an existing in-person ward, a community team, or from a GP practice. A virtual ward coordinator – usually a senior nurse or practitioner will have responsibility for the day to day operations of the ward.

Patients will be assessed for their suitability for admission and rated accordingly. The virtual ward coordinator will then select the most suitable care plan, depending on the virtual ward set-up and technology available.

A key function of all virtual wards is monitoring the status of patients remotely with a risk stratification model in place. Depending on the needs of the caseload, this can be conducted in a number of ways:

    • Remote monitoring tools
      For patients who can monitor their own health, specialist software can be used to report results directly to community teams. This commonly involves delivering essential monitoring equipment such as pulse-oximetry and blood pressure monitoring devices. Patients are assessed as being competent in monitoring their health, and upload their data via an app or a call to a clinician. Any concerning results or missed uploads are then highlighted for further intervention as per guidance.
      This approach has been shown to work well for Covid patients who may be at risk of hospital admission but instead, the patient is in control of their own health with frequent contact and oversight by the responsible clinical team.
    • Video conferencing 
      Video conferencing offers the opportunity to give a visual assessment of the patient and their general condition. Video calls bring the professional into the patient’s home instantly to allow the clinician to make a clinical consultation with a view to confirm if an actual home visit is required. ‘Seeing’ the clinician can also provide the feeling of human contact which may be particularly valuable to a patient who is required to isolate.
    • Telephone calls 
      In areas where other technology isn’t available or isn’t suitable for the patient, telephone monitoring as a ‘virtual visit’ may give the best window into their current health. This can be done routinely, or as a follow up to another intervention to further assess the patient’s status without physical contact.
  • Home visits 
    Home visits can provide essential direct care, without the need for hospital admission that may further risk the health of the patient. A thorough telephone assessment informs the clinician if a home visit is required, and ensures that a correctly skilled clinician attends to the patient to carry out the required interventions. This limits the potential number of home visits and the associated risks.

With staff shortages at an all-time high, Civica’s clinical e-scheduling software can manage caseloads for multi-disciplinary teams whose staff may be isolating but are able to work remotely.

Civica Scheduling gives clinicians full visibility of their patient’s needs, including whether a virtual or a face-to-face visit is required – minimising clinical risk and making sure no patient is missed. Efficient allocation of equipment, such as pulse oximeters, can be easily tracked through the system.

Reliable data capture means staff with varying skill sets can be quickly redeployed to where they are needed the most to support patients at home – making teams more agile and reducing the pressure on hospitals, community health and social teams and primary care services.

When can virtual wards be used?

A virtual ward model can be implemented for any patient group that can safely be cared for from their home, a residential home, or supported living setting and would benefit from avoiding hospital admission.

Read more on the past, present and future of community nursing.

Where small, dedicated teams are used, this allows for knowledge of each patient to build in a way that is not usually possible when continually seeing different practitioners at the primary and acute care stages. This is of particular benefit to patients with chronic long term conditions and allows for more personal, accurate assessments of their health and the need for intervention.

This could include:

  • Covid-19 and Long Covid
  • 2-hour urgent response / 2-day urgent response for therapists 
  • Chronic obstructive pulmonary disease (COPD)
  • Other respiratory conditions
  • Heart failure
  • Complex wound care
  • Post-surgical rehabilitation 
  • Physiotherapy 
  • Admission avoidance in residential homes.

Civica Scheduling can support virtual visits for your virtual ward. Contact us to find out more.