Mary DeCourcy was in St Vincent’s University Hospital in Dublin after having a coronary stent inserted when she was asked if she would be interested in becoming one of the first patients to be enrolled in a new “virtual ward”.
It would mean she could return to her home in Wicklow town, which she had left in the back of an ambulance a few days previously, while remaining under the wing of the hospital’s nursing and medical teams via remote monitoring. She would still be considered an “inpatient” until deemed ready to be discharged from the hospital’s care.
DeCourcy, who is in her late 60s, jumped at the idea, because she has a great interest in technology, as a retired IT worker with Wicklow County Council, and it also meant she could be reunited with her canine companion, Scruffy, who was being minded by her sister. “I was excited but nervous at the same time,” she says. “My brother brought me home and we had the kit in the car.”
She had been shown how to use the various devices for measuring blood pressure, pulse, oxygen saturation, temperature and weight. These transmit the results via Bluetooth to a tablet, from which she was to send them on twice a day to the virtual ward’s digital hub in the hospital. She had also been assured she had a direct line to a nurse at all times as they staff the hub around the clock.
“It was like having my own nurse on call because I knew, once or twice, if I got a bit nervous, I could just ring and the nurse would be there on the phone instantly. If there was any wobble in my blood pressure or pulse or anything like that, I’d get an immediate call from the actual nurse.
“One of the early days I had put the [blood pressure] cuff on upside down and the nurse was on to me in jig time: ‘Have you died or what?’,” recalls DeCourcy with a laugh. She could also send text messages.
“The biggest benefit for me was that I could relax at home again because I live on my own.”
The monitoring and back-up gave her peace of mind as she adjusted to the feeling that all was okay now with her heart beat. “It came as a bit of a shock when I had to give it back then after three days,” she says of the kit. So much so, that the hospital said she could hold on to it for a couple more days until she felt ready. “When I did finish using it – and obviously my medication has been stabilised – I haven’t had any issues since.”
It is a ward round with a difference when the cardiology team gather at the digital hub in St Vincent’s (SVUH) at noon each day. The patients they are reviewing are all in the virtual ward. “We have big digital whiteboards on the walls and we go through each patient,” says Aoife Halpin, clinical nurse manager 3 on the virtual ward. The consultant and other medical staff can click on the patient’s electronic file to see all the latest observations and also go through responses in the questionnaires that patients submit twice a day. The patient’s recovery trend will be discussed, dose of medication altered if necessary and discharge prospects reviewed.
The content of this ward round is the same as in any other ward, she says, “it is just done in a different manner”. While the consultant’s team doesn’t routinely call the patient, if there was a concern on either side, “they would 100 per cent call them”, says Halpin, and a nurse checks in with the patients at 10am and 6pm each day. Nurses are also automatically alerted if a patient has not submitted their readings on time, so they can follow up to see if there is a problem.
Rollout of the virtual ward service started on July 1st and the initial focus is on early discharge out of hospital for cardiology and respiratory patients in SVUH and University Hospital Limerick. Up to August 18th, 491 virtual bed days had been used by 107 patients, according to the Health Service Executive (HSE). The direct benefit for the health system is that it frees up physical hospital beds but advantages for the patients, such as a lower risk of hospital-acquired infections, less deconditioning and a psychological boost from home comforts, are also mutually beneficial.
“Virtual wards have evolved from pressures healthcare systems face in unscheduled care, pressures which increased during the pandemic,” says HSE chief clinical officer Dr Colm Henry. “For some patients, monitoring by clinical teams who harness technology can offer a safe and preferable alternative to inpatient hospital care.” It empowers individuals to be active partners in managing their health and wellbeing.
“Experience in other countries has shown that pathways can be developed across many specialties safely and effectively, ensuring that eligible patients can access the same care they would in hospital settings while avoiding their inconvenience,” he adds.
NHS England launched its national virtual ward programme in April 2022 and a thorough evaluation of its impact is yet to be done. One study in the southeast published last May found evidence of virtual wards being linked to a reduction in unscheduled hospital admissions and to positive net financial benefits.
It’s week six of piloting the innovation here as Halpin talks to The Irish Times and there are 11 patients on the SVUH virtual ward that day. Although no longer on the premises, these patients “are still being cared for by highly skilled nurses”, she stresses, “and they are still considered as inpatients”.
They keep their wristbands on and, if they were to have an acute episode that necessitated a return to the hospital building – which has not happened so far – there is a dedicated bed waiting. There would be no question of them having to go back through the emergency department to get a bed, she says. A length of stay on the virtual ward varies but typically it is five days.
Patients would mostly have been admitted to the hospital through the emergency department, or some other channel, for acute treatment and have spent a few nights there before being identified as appropriate candidates for the virtual ward and given the option. The hospital team would need to be satisfied that they were medically stable and check, through next of kin, that their home situation was suitable and there would be somebody there to support them with the technology, if necessary, and any other needs.
There is no arm-twisting if they don’t fancy the idea, but most patients are only too delighted at the prospect of getting “more than likely the good night’s sleep and some decent food”, says Halpin. The kit is designed to be very user-friendly but if there are any doubts about the patient being able to use it, they would not be transferred.
“The way I look at it, anyone who has a smartphone can use it, it is that simple,” she says. “We go through it all with them step by step. They do their first set of vital signs while they are still here in the hospital so that we know they are safe to do it.”
[ Just how unsafe are emergency departments in Irish hospitals?Opens in new window ]
The basics being monitored for all is blood pressure, heart rate, oxygen saturation and temperature. Depending on the condition, there are extras that can be added on. For instance, heart failure patients may be sent home with weighing scales; those with an irregular heart beat may be also given a device for ECG tracing, while COPD patients have a peak flow meter to monitor breathing.
Feedback from patients has been amazing so far, reports Halpin, who, having come from being nurse manager in the hospital’s emergency department, is not used to such positivity. “We’ve had 50 patients through our virtual ward so far in six weeks and we haven’t had one negative feedback.”
Halpin and her team are also enthusiastic about this brand new way of nursing. “It’s different, but I think most of the staff have loved it because they really get more time with the patient,” she adds.
Clinical nurse manager 1 of the virtual ward in University Hospital Limerick, Linda Hartley, echoes those comments about patient and staff satisfaction. She sees it as a very patient-centred way of working and one which improves communication.
“It’s great. You get to know the patient on a different level,” she says of video call conversations, during which they get to see the patient in their own surroundings. “You nearly know by speaking to them how they’re doing at home. We’re trying to pick things up that we might be missing if they’re not telling us. So there’s lots of questions that we ask.”
She also finds that patients become more active in managing their recovery and raising issues themselves. Unlike on a conventional ward, where a group of people swarming around your bed on a ward round can be quite intimidating, she points out, patients are more comfortable asking questions remotely.
The nurse-led virtual ward, which has space for 10 in Limerick, is a way of increasing the hospital’s acute bed capacity, while saving on services such as catering, house-keeping and portering. The only downside Hartley can see to what is “a very safe service” is that the technology, although very user-friendly, can be a barrier among the ageing population. But they can get around this if there is family close by to assist.
As a nursing manager, she has found it exciting to be involved in such a new line of work and she too is gratified that patients “really love it”. They have had people not wanting to return the kit, so it would be there in case they needed it again.
Jim Murphy (70), who had a cardiac stent fitted at University Hospital Limerick on July 22nd last, was very comfortable being enlisted for the virtual ward the following morning. “These days with Covid and everything else, you’re better off getting out quick aren’t you?”
As a former aircraft engineer, the electronic gadgets didn’t faze him. He had devices for measuring his blood pressure, temperature, pulse and oxygen levels twice a day. In video calls with the hospital he would turn the tablet’s camera towards the stent’s entry point on his right wrist so they could check it was not showing any sign of infection.
“You hear this and that about Limerick hospital and the emergency [department],” he adds, “but they were extremely professional. I couldn’t praise them enough.”
Both Halpin and Hartley believe that as word of the scheme spreads, there will be a lot of interest from patients.
After all, who would not prefer to be back in their own bed sooner rather than later?
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