Organisation

South West London ICS, Sutton Borough Team.

The aim

To reduce avoidable hospital admissions and length of patients stay in hospital.

The solution

Patients admitted to the virtual ward are supported by multi-disciplinary teams (MDT) of specialists from across systems including GPs, hospital consultants, advanced nurse practitioners (ANPs), paramedics, social prescribers, pharmacists, social care professionals and MDT co-ordinators – a great example of partnership working.

Sutton Primary Care Networks in partnership with Epsom and St Helier hospitals and Sutton Health and Care joined together in 2021 to develop the Sutton Community Virtual Ward building on the success of the Community Response Team service which provided care and support to the most vulnerable unwell patients and families in their own homes during the early days of the COVID-19 pandemic.

Challenges

Challenges facing the virtual ward include workforce recruitment, reduction of hospital readmission and increase in patient self-care using telehealth remote monitoring services.

Results

Capacity for up to 100 ‘virtual beds’ at any one time and length of stay in hospital has dropped by an average of two to three days, which has helped ease the pressure on acute beds at Epsom and St Helier Hospitals during a very busy time.

Medication review for patient has led to reduction in medicines waste, and improved medicines safety. Single clinical system EMIS reduces bureaucracy, delays, improves communication between primary and secondary care and enables pharmacists to review medication safety.

A care plan is put in place and patients’ care is co-ordinated via MDT “virtual ward rounds” which happen three-times a week. Patients’ records are updated immediately after each ward round and are available to all professionals involved in their care.

Patients receive regular face-to-face visits from an Advanced Nurse Practitioner and following clinical assessments, enhanced support is provided via remote monitoring of vital signs – such as blood pressure, temperature, and oxygen saturation up-to-four times daily (or as recommended).

Patients are provided with remote monitoring devices which are assessed virtually by the patient’s GP and other members of the MDT. The remote technology means that any signs of deterioration in the patient’s condition can be treated very quickly and safely.

Sheila, 89-year-old Sutton Community Virtual Ward Patient is delighted with the service, ‘I was feeling quite ill, and I went to the doctor’s surgery, and he told me I had shingles. I didn’t realise just how bad one could feel with something so simple. But the nurse from the virtual ward came in to see me every day. The virtual ward has kept me at home, able to cope and nursed me back to health. I think it’s a wonderful service.’

Learning points

Dr Robert Odes, Consultant Physician, Frailty Medicine at St Helier Hospital, believes that the virtual ward has changed the way that the hospital practices medicine. “Before, patients spent many days in our hospital wards but now we can safely and efficiently discharge patients into the community where they receive their last three to four days of treatment in the community. Patients prefer it, their families prefer it and, importantly, we know it’s safe,” he said.

Minal Karia, a Senior Primary Care Pharmacist who reviews patients’ medicines on the virtual ward, said: ‘We can look at all the medicines a patient is taking and make sure, for example, that they are taking the correct dose or if there are any drug interactions causing side-affects. Sometimes medications have been started but may not have been reviewed and the patient does not need to take them anymore. It’s as important to stop medications that aren’t needed as it is to start them.”

Next steps?

To continue to develop and support the virtual ward. Dr Anthony Ditri, GP at Chesser Surgery, who refers patients to the virtual ward, said: “I feel a lot more confident in managing people who are discharged perhaps a little earlier than they otherwise might be. Patients are happier to be in their own home and they are less fearful.”

“At the moment, I have a lady in her late 60s, who is really worried about going into hospital. With the virtual ward, we are able to keep her at home, with her family looking in on her. I am a lot more confident that she is safe staying at home and that she is getting the medical advice she needs.”

Find out more?

Contact: england.stcomms@nhs.net