Applying a COVID Virtual Ward model, assessing patient outcomes and staff workload

Abstract

A COVID virtual ward (CVW) is recommended by NHS England, but ‘usual care’ outcomes have not been reported. A retrospective study of all adults with COVID-19 attending Queen Elizabeth Hospital Birmingham between 01/06/2020-31/01/2021, assessed against CVW criteria and followed for 28 days. Of 2301 COVID-19 patients, 571(25%) would have met CVW criteria. Of these, 325(57%) were discharged after review and 246(43%) admitted. Of admitted patients who met CVW criteria, 81% required hospital-supported therapies; 11% died. Of the 325 discharged, 13% re-presented, 9% with COVID-related symptoms, 2% required intensive care admission, and one died (0.3%). In this comparison, discharging patients without a CVW did not lead to more re-presentations, re-admissions, ITU escalations or deaths compared to published outcomes for hospitals with a CVW.

Variability and performance of NHS England’s ‘reason to reside’ criteria in predicting hospital discharge in acute hospitals in England: a retrospective, observational cohort study

“…This has been recently discussed for NEWS2, 20 sepsis alerting and COVID-19 virtual wards. 21 R2R has been endorsed and adopted but without validation or consideration of the unintended consequences of its application. This is not to contend that a significant number of in-patients could not be discharged earlier, simply that there is no evidence that R2R can support clinical decision making.…”

“…There is significant opportunity for unintended consequences to arise from the implementation of poorly considered clinical decision support,19 particularly when there is competition for clinical resource. This has been recently discussed for NEWS2,20 sepsis alerting and COVID-19 virtual wards 21. R2R has been endorsed and adopted but without validation or consideration of the unintended consequences of its application.…”

The variability and performance of NHS England’s “Reason to Reside” criteria in predicting hospital discharge in acute hospitals in England. An observational study

“…There is significant opportunity for unintended consequences to arise from the implementation of poorly considered clinical decision support (18) , particularly when there is competition for clinical resource. This has been recently discussed for NEWS2 (19) , sepsis alerting and COVID-19 virtual wards (20) . R2R has been endorsed and adopted but without validation or consideration of the unintended consequences of its application.…”

Virtual hybrid hotel care model for the surgical patient: New goal of global academic surgery to improve global outcomes

“…Some examples of recently reported evaluated models were related to the surveillance and management of COVID-19 patients [ 9 , 10 ]. One of the most prominent is the COVID Virtual Ward model [ 10 ], which was initially proposed and implemented in England, consists of granting early hospital discharge to those stable patients with a mild-moderate COVID-19 phenotype, who would be strictly monitored and given a home management kit. Gallier et al [ 10 ] evaluated this model, showing that 13% were readmitted, 2% required intensive care management and 0.3% died (1 patient).…”

“…One of the most prominent is the COVID Virtual Ward model [ 10 ], which was initially proposed and implemented in England, consists of granting early hospital discharge to those stable patients with a mild-moderate COVID-19 phenotype, who would be strictly monitored and given a home management kit. Gallier et al [ 10 ] evaluated this model, showing that 13% were readmitted, 2% required intensive care management and 0.3% died (1 patient). This type of results, promoted the transformation of virtual care as a reality, so the nursing staff should be trained and redirect strategic directions to support this type of models [ 9 ].…”