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Thought Leadership

Virtual wards have sparked a new era for remote care – what happens next?

01 September 2022

Virtual wards had been hovering in the background until Covid thrust them into the spotlight. Their expansion is now one of the top priorities across the NHS for 2022 and beyond. Remote monitoring platforms, used for many years for LTC management and enhanced care in care homes, are a crucial tool for enabling safe virtual wards.

The pioneering efforts of the Trusts that used digitally enabled virtual wards to cope with the pandemic mean that we now have an unprecedented depth of digital experience and use cases. At Frimley Health NHS Foundation Trust and West Berkshire, for example, where clinicians have used a Covid virtual ward to support more than 14,000 people since 2021, resulting in reduced pressure on hospital beds and staff.

The key now will be using those blueprints and experiences to expand into remote monitoring of other conditions and specialties – as we move towards a future of seamlessly integrated care from home to hospital and other care settings.

Beyond Covid

Hospitals have been expanding the use of remote monitoring to support their virtual wards across a range of disciplines. We have seen its use in areas such as respiratory, cardiac, paediatrics, frailty and MND.  For example, Mersey Care NHS FT and Liverpool University Hospitals NHS FT launched a virtual heart failure ward in May 2022 – only the second in the country.

For about 14 days, in the comfort of their own homes, patients take observations three times a day including temperature, blood pressure, oxygen levels and ECG. Realtime alerts flag if any thresholds have been exceeded, and clinicians view the data and decide if an intervention is required, such as an outpatient attendance for intravenous diuretics to remove excess fluid. The aim is to recruit 200 patients in Cheshire and Merseyside by November 2022, which it is estimated could save about 1,500 bed days in hospitals and £540,000 in costs.

Coventry and Warwickshire has established virtual wards in its acutes for respiratory and cardiac, and Black Country ICS has seen the country’s first paediatric respiratory virtual wards established. In just three months, it has managed 120+ children at home, and proven the benefits, not only in utilisation but also in significant reduction in Co2 emissions.

Thinking beyond hospitals

Much of the work in virtual wards to date has been for “step-down,” enabling patients to be sent home, but we need to start thinking in broader terms, and working towards better integration across health and care communities. The “step up” model, where admissions are avoided, offers huge benefits and blends perfectly into the Virtual Care model, where proactive remote monitoring is used with LTC patients, and residents in care homes, to detect deterioration and intervene. When you look beyond the acute setting, 2-4% of the population have a level of severity in their chronic conditions where remote monitoring is proven to have a significant effect in reducing health care utilisation, such as 999, ED and emergency admissions.

Taking care homes, for example, remote monitoring can help manage the wellbeing of residents, promotes their independence, reduces the need for GP visits, and delays the need for a move to higher levels of care. The London Borough of Bexley has successfully united health and social care for the benefit of care home residents by deploying Docobo’s DOC@HOME remote monitoring technology across its care homes. Staff are reporting numerous benefits such as the ability to share important information with GPs faster, and easier.

Kelly Winship, Deputy Manager at Parkview Care Home, explains:

A lot of the time we pick up on signs and signals from our residents, but now we have the blood pressure and other readings that we are able to pass on to the GP. We also now know, for example, if one of our residents has a change in behaviour, to check for a possible UTI. If they have ill health like a rash or cellulitis, for example, we can take a photo and send it via Docobo. It’s so much quicker now.

What’s next?

Whilst progress is being made with virtual wards and remote monitoring up and down the country, we have only
scratched the surface.

Digital maturity. We need to recognise that remote monitoring is just one part of the digital puzzle. The logistics
of carrying out remote monitoring, coordinating specialists and liaising with others that may be involved (GPs,
community teams, etc) cannot happen without a certain level of digital maturity. This includes having a shared
care record
 to capture the information and ensure access for all the professionals involved in that person’s care.

Improved selection methods. We need to get better at finding the right cohorts of people in order to get a return
on investment. Population health and shared record solutions,which are becoming increasingly widespread, can be
used to identify patients that would benefit from remote monitoring at home – a technique known as precision
cohorting. By using data from all care settings, Trusts and ICSs will be able to improve on more basic selection
methods such as national clinically vulnerable lists. 

Putting people at the heart. Most importantly, we need to remember what is at the heart of virtual wards and
remote monitoring: people - and keeping them safely in their own home, which is where the majority of us would
rather be, if the option exists. Patient communication is crucial, ensuring that they are comfortable with the
monitoring equipment and what they need to do with it. You can have the best tech in the world, but it is of no
use if your compliance is through the floor.

Innovations like Docobo’s CAREPORTAL®, a tablet-like medical device that is simple to use, and can easily acquire
ECG and breathing rate, are steps in the right direction, and provide a glimpse into the future. More in this vein is
needed if we are to reduce health inequalities and ensure that thousands of people have access to the benefits
of remote monitoring over the coming years.

By Adrian Flowerday, Managing Director of Docobo Ltd, part of the System C & Graphnet Care Alliance.

Adrian Flowerday

Adrian Flowerday,
Managing Director of Docobo Ltd.