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Tech-enabled virtual wards: relieving pressure on the NHS while caring for patients at home
Early on during the first wave of the pandemic, NHSX supported a pilot that gave COVID-19 patients a pulse oximeter and an app. This meant they could leave hospital early, or avoid admission altogether.
The app and oximeter enabled patients to provide their NHS clinical team with regular data on symptoms including temperature and blood oxygen rates so that they could recover while being monitored in the comfort of their own home. And if they deteriorated, clinicians would be quickly alerted and care would be given. This model is called “tech enabled virtual wards” or “remote monitoring”. It was first pioneered for COVID-19 by Dr Matthew Knight, MBE, and Dr Andy Barlow at Watford General Hospital in March 2020 to prevent hospital admissions, assist early discharge and ease pressure on staff. By June 2021, it was available at 92 sites across England.
Although this innovative approach was a direct response to news and images from across the world where hospitals were becoming quickly overrun by COVID-19 patients, over subsequent months, NHS organisations began to support people at home with health conditions other than COVID-19. Dr. Matthew Knight was appointed a Member of the British Empire (MBE) in the Queen’s Birthday Honours.
This built on the “virtual ward” model first used in Croydon, south London in 2004 developed by Dr Geraint Lewis and colleagues, and added to this simple digital tech to enable ongoing monitoring at home.
Matthew Knight and Andy Barlow's case study
Matthew Knight is respiratory medicine consultant at Watford General Hospital, part of the West Hertfordshire NHS Trust. Andy Barlow is respiratory consultant and divisional director of medicine at West Hertfordshire NHS Trust.
“As the severity of the pandemic was becoming clearer in March 2020, my colleague, Dr Andy Barlow and I sketched out a new virtual ward pathway for patients with suspected COVID-19. In Italy hospitals were quickly overrun with COVID-19 patients. Our concern was to prevent this happening at our Trust.
“The ultimate aim was to prevent hospital admission and facilitate early discharge, by providing specialist remote care to patients 7 days per week at home. For this we needed data, provided remotely; data on a patient's oxygen levels, pulse, respiratory rate, blood pressure and temperature, as well as their symptoms.
“A week later the COVID-19 virtual ward took its first referral from Watford’s A&E department. A year on, we've cared for over 4,000 patients in the comfort and safety of their own homes, with excellent outcomes from a patient safety perspective.
“In the first 8 weeks of wave 1 we cared for over 900 patients. However we started experiencing problems with gathering and sharing information from patients and between teams which was hindering our ability to take more referrals. Our collaboration with NHSX and the tech company Huma helped resolve these issues. We estimate our virtual ward to have saved hundreds of bed days at a time of intense pressure for the Trust, allowing clinical teams in the hospital to focus on those needing more intensive care.
“Having patient data such as oxygen saturations readings, heart rate and temperature and symptoms in a structured and objective way meant we were able to double the number of patients we could care for simultaneously. At one point in wave 2 our virtual ward was vital for simultaneously caring for over 400 patients. The virtual ward allowed clinicians to work quickly through large amounts of patient collected data allowing me and my team to identify and focus on the 8.4% of patients who needed to be readmitted. In some cases we were able to identify deteriorating patients long before they themselves presented these symptoms, undoubtedly saving lives.
“Interestingly, the 3 month readmission rates for patients cared for via the virtual ward post discharge appear to be significantly lower than the national average.
“I'm glad to say this story doesn't stop here. Off the back of the success of this data centred model of care, my hospital is expanding the virtual ward service to cover more conditions such as COPD, heart failure and asthma. Caring for patients effectively requires amassing and sharing large and continuous streams of data about the patient’s condition. These include physiological parameters, movement, symptoms, as well as an efficient way of facilitating two way communication, reassuring the patient that their data has been reviewed and that all is in order.
“Using technology has allowed us to unite the limited resource of specialists with patients in need, providing high quality specialist-led care. Working with the team from NHSX has helped us develop services which are clinically safe, effective and data driven and secure. How far we’ve come in a short space of time. This really is the way forward for many aspects of patient care.”
Elizabeth Peerless' story
“In March 2020, before COVID-19 really took hold in the UK, I woke up in the night to find that my index finger on my left hand had a large blister. I had no idea what had happened, thinking maybe I had banged it during a seizure, but couldn’t recall.
“Luckily, at the time, my daughter was living with me and was concerned too, so she called NHS 111. They felt it needed medical attention and called for an ambulance to take me to A&E. They took X-rays, but doctors couldn’t work out what it was either, so they referred me to Queen Victoria Hospital, which is a specialist hands and burns hospital.
“I saw four different doctors and was rushed to theatre for further investigation. I woke to find my left index finger had been amputated and was told that whilst in theatre they had determined that it was necrotising fasciitis, a rare bacterial infection that spreads quickly in the body and can cause death. If it hadn’t been operated on straightaway I could have died within 24 hours.
“I spent nine days in hospital and by the time I was discharged we were in a national lockdown. To minimise the number of hospital visits for dressing changes and physiotherapy on my hand, remote monitoring was put in place. My daughter changed my dressing and took photos, which we sent the night before my telephone consultations, so that they could be reviewed and discussed with me during the phone consultation the following day. I also had to have six months of physiotherapy, which were mainly carried out as video consultations instead of face-to-face appointments.
“I have made a good recovery and have found remote monitoring really convenient - it really feels like the way forward now and will really revolutionise the way healthcare is delivered now, and in the future. I’m all for it.”