Preoperative virtual ward reducing bed occupancy through monitoring of hot gallbladder

The first virtual ward launched in February 2021 at Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) was set up to manage respiratory patients at home as an alternative to care in an acute hospital bed.

Since then, additional clinical pathways have been introduced to allow expansion of virtual wards, to include pre- and post-operative management, diabetes care, maternity, COVID, palliative care, heart failure, Chronic obstructive pulmonary disease (COPD) and sepsis management.

Situation

Patients with acute cholecystitis present to the ED (Emergency Department) or their GP (General Practitioner) with symptoms of abdominal pain, nausea, vomiting and possible blood in urine. If the patient is in the ED, they are triaged by the surgical assessment team.

If the patient presents to their GP conservative management is suggested until the patient is unable to cope with symptoms and therefore presents at ED.

If the patient needs a cholecystectomy, they are scheduled for surgery and admitted into the virtual ward for monitoring until their procedure takes place.

The virtual ward team monitors patients’ vital signs (including temperature), determines sepsis risk, and monitors’ pain.

Aspiration

The Trust virtual ward team aims to safely monitor and manage patient’s symptoms at home while they wait for gallbladder surgery. This would ensure hospital beds are kept free for patients who need acute hospital care.

Solution

Current Health provides the digital health technology powering this care pathway within the NNUH virtual ward.

This technology combines a continuous remote patient monitoring (RPM) device, intelligent patient alarms, telehealth, messaging and survey capabilities, and a provider application and dashboard.

The care-at-home platform allows for ongoing insight into each patient’s condition and enables the virtual ward team to intervene with patients as needed.

This care pathway has reduced reliance on inpatient beds for this procedure.

Impact

• 150 hot gallbladder patients treated on this pathway so far.
• Approximately 1000 acute bed days saved (Feb 2021 - June 2022), a significant reduction of physical in-patient bed occupancy.
• 100% of patients under this pathway would use the virtual ward service again.
• This pathway enables patients to maintain control over symptom management in addition to optimising pre-operative wellbeing, with the reassurance of continuous monitoring and rapid access to registered nurse support.
• This pathway patients continue to have direct access back to acute care should their clinical condition change.
• In the last 6 months, less than 5% of hot gallbladder patients have required escalation back to a physical hospital bed whilst awaiting surgery.

Functionality

Through a wearable sensor worn on the upper arm, the platform continuously captures patients’:

• respiration rate
• oxygen saturation
• heart rate
• body temperature
• movement data

Patients have video and text consultations using a tablet device which is provided as part of the Current Health kit.

Capabilities

Current Health’s care-at-home platform:

• Enables patients to be monitored at home.
• Enables the virtual ward team to complete video patient assessments on the patient’s tablet.
• Helps the virtual ward team see both real-time and trend health data through a centralised dashboard.
• Has alarm notifications to alert the team to the early signs of deteriorating health, enabling them to deliver treatment.

Scope

Healthcare providers use Current Health’s platform to deliver clinical care to patients at home.

Key learning points

• Enabling staff in acute areas to complete transfer to virtual ward and relevant consent improves flow of patients through the pathway.
• Ensuring patients are transferred home with relevant analgesia and anti-emetic medication in addition to symptom management advice and reduces risk of escalation.
• The pathway has proved successful, and use has steadily increased.

Digital equalities

• Patients are provided with a tablet, to ensure those without a smart device can still access the care team.
• A connectivity hub ensures data transmission through the cellular network (reducing reliance on in-home high-speed internet).

Key figures and quotes

“The kit was so simple to set up and I was reassured that my readings were seen by the nurses. Video calls gave me time to talk to the nurse and I am sure my recovery was down to being at home with my husband and dogs and the amazing care I received. All patients should be offered the virtual ward”

Bea, NNUH virtual ward patient

"Continuous monitoring ensures our patients are safe at home. We have instant visibility of the condition of our patients which helps us carry out virtual ward rounds more effectively."

Emily Wells, CNIO, NNUH

Find out more

Current Health

Key contact

Katherine Cooper, Deputy Sister, NNUH Virtual Ward

Katherine.Cooper@nnuh.nhs.uk

Rose Cary, Deputy Sister, NNUH Virtual Ward

Rose.Cary@nnuh.nhs.uk

Louise Hough, Director, UK Customer Operations, Current Health

louise.hough@currenthealth.com