Case study: providing rapid care to people in their own home rather than going to hospital, through a frailty virtual ward in Leeds

Summary

This virtual ward in Leeds supports up to 40 patients per day and provides co-ordinated rapid care to people aged over 70 with moderate to severe frailty in their own homes.

Together, they have saved nearly 10,000 bed days since launching the pilot virtual ward in November 2019.

How does the virtual ward work?

The virtual ward is integrated into existing neighbourhood teams. Patients can be referred into the ward by GPs, the ambulance service, hospital teams, other specialist community services or from other parts of the neighbourhood team. Referrals are received through a single point of contact.

Community matrons assess people in their homes within two hours of being referred including undertaking blood analysis. The outcome of the assessment is discussed with the consultant geriatrician to ascertain if they are suitable for care at home on the virtual ward followed by a discussion with the patient and their carers.

Once on the virtual ward, patients are supported by daily interventions such as medication reviews, subcutaneous fluid administration, blood monitoring, clinical observations and review at the consultant led multidisciplinary team meeting.

How was the virtual ward set up?

A multi-organisational development group was established to set up the virtual ward. This bought together primary, secondary and community health colleagues as well as representatives from adult social care, mental health and the third sector. Together, the group developed our virtual ward model including, most critically, the need to have pharmacy and overnight support alongside the referral criteria.

How has the virtual ward benefited patients?

Patients and their carers told us they felt listened to, treated with dignity and respect, and they have improved trust and confidence in virtual ward professionals.

One person who experienced the virtual ward said: “I think that should be the standard care, who wants to go to hospital, when you can have the people [matrons] to help you at home and get better while sleeping in your own bed!”

Another person told us: “I was taking an awful lot of tablets, rattling around I was, but [the pharmacist] came and sorted that out so I am taking less now. They thoroughly explained things and things that I didn’t even know about my body”. The patient said the virtual ward team “turned things around for me, sorted out my tablets and got me back on my feet…everything about the team was a positive for me”. 

Caring for people in their own homes has contributed to fewer hospital-acquired infections, falls and complications. For example, patients with delirium can find admission very distressing, so these patients are cared for much more successfully at home.

How have you found working on the virtual ward?

Staff said it’s been a positive experience. Their team meetings have enabled them to consider people’s care and are well attended by relevant professionals. They value multi-disciplinary working and the wards’ culture of learning and collaboration.

The team said:

I would say that improved working relationships, understanding and collaboration between Leeds Community Hospital and Leeds Teaching Hospital Trust has been one of the really positive things to come out of the virtual frailty ward. I have really enjoyed working with and getting to know the matrons

Geriatrician

We are definitely and unquestionably keeping people out of hospital…I see this on a day to day basis and all of the patients on the virtual ward are reasonable hospital admissions so we have a whole ward’s worth of patients not in the hospital…how can that not be a good thing for the wider system

Geriatrician

The virtual ward [frailty] has definitely enhanced the role of the matron and added a new element where we can put our clinical skills to best use…for me the virtual ward has been a really good learning opportunity and I really enjoy that element of the role

Matron

The virtual ward has supported patient flow and improved collaboration between acute, community and third sector services.

What would your top tips be?

  • Establish your project support, management and formal evaluation team.
  • Learn from what’s already out there, locally, regionally and nationally.
  • Consider night care and pharmacy – this was critical to our model in terms of hospital avoidance and understanding the cause of some referrals.
  • Speak to your workforce, always include them from the beginning. Make sure you include every relevant person in the process. Constantly be open to receiving feedback and make changes and adapt as you go.

Author: Angela Gregson, Clinical Development Lead, Frailty Virtual Ward, Leeds Community Healthcare NHS Trust