Embedding virtual wards across England - Dr Sarah Sibley

Respiratory Futures spoke to Dr Sarah Sibley, Consultant Chest Physician and Community Respiratory Clinical Lead in Cheshire and Merseyside, about her experience of setting up virtual wards. Among her many roles, Dr Sibley is the Integrated Care Lead for the British Thoracic Society and the Virtual Ward Clinical lead for NHSE North West.

Tell us about the virtual wards project and how it came about?

Very early on in the pandemic, it was hard to know who needed to be admitted to hospital and who could be managed safely in the community.  It became apparent that a patient’s level of hypoxia (low levels of oxygen in their body tissues) clearly predicted mortality and morbidity and could be used to triage care. 

Unusually with acute COVID infection, silent hypoxia was relatively common so pulse oximetry (a test to measure oxygen in the blood) at home became a key measurement. In Merseyside and Cheshire, we started monitoring people’s oxygen levels in the community, this really caused a revolution in the way we cared for people. We realised we could monitor and care for people in the comfort of their own homes in a different way than we had before.

The virtual ward was inspired by this, supporting people with COVID-19 and helping them to be discharged from hospital earlier. We provide hospital-level care for them in the comfort of their own home. Our virtual ward also now supports people with other acute respiratory infections (ARI).

How did you develop the project?

The virtual ward was developed by clinical teams in St Helens and Knowsley Teaching Hospitals NHS Foundation Trust, Liverpool Heart and Chest Hospital and Mersey Care NHS Foundation Trust working together.

To set up the virtual ward, we educated hospital-based staff about who could be on the virtual ward, and how we worked. That was no easy task – it required strong, clinical leadership and also a step-by-step building of trust. Our brilliant respiratory specialist nursing team assessed patients that were referred to decide who might be suitable for the virtual ward, and also helped us adapt our admission criteria to safely meet the needs of patients.

Along with other virtual wards across the country, our COVID virtual ward has now evolved to support people with a range of respiratory conditions. Moving from a COVID virtual ward to an ARI virtual ward, was more challenging than first anticipated! 

Patients have a range of diagnoses necessitating admission on the virtual ward and may (or may not) also have chronic underlying respiratory illnesses.  We wanted to ensure that the care delivered on a virtual ward fully encompassed evidence-based practice, whilst pushing the boundaries of what can be delivered outside a hospital.  Safety is always a key consideration and by utilising technology, we are able to monitor patients’ symptoms and observations to a similar extent as on a physical ward, but in their own homes.

So far, we have helped over 400 people through our ARI virtual ward, giving them hospital-level care at home. We have been careful to ensure that patients are not excluded if they struggle to use digital tools and have a range of options available.

What challenges did you face?

Initially, I was unsure about virtual wards. I didn’t think we’d be able to maintain personal contact with the people that we care for. But then I saw first-hand how you could provide excellent care to patients with self-monitoring and treatment, which is just as effective as if they were in a hospital bed. As a result, I quickly became an advocate.

So far, the virtual ward is working well for our Trusts and our patients. Many of our patients are happy to be cared for in this way and have given good feedback. For example, Joan, who we cared for after a heart attack and COVID, said: “the nurse rang me every day, she asked me all the different questions about my health and I didn’t have to do anything, it was all done for me. It was very good, very thorough”.

Is your work being rolled out elsewhere?

Our virtual ward is one of many being established, across England.  Virtual wards have the potential to effectively manage many people outside of a hospital and bring a high level of expertise and therapy to patients in their own homes. Virtual wards help the NHS manage more patients concurrently and release highly valuable hospital beds.

If we can increase the level and complexity of care that patients can receive outside of a hospital building, we will release hospital beds so that patients awaiting elective procedures can have their waiting time reduced and we can improve flow through the emergency health services, improving ambulance response times and reducing the number of patients waiting on trolleys in Emergency Departments.

What tips do you have for clinicians wanting to set up a virtual ward?

I’d really advise clinicians starting on their journey to connect with others. Only by sharing our successes and knowledge of what doesn’t work, will we be able to innovate at speed. As part of its national virtual wards programme, NHS England is developing networks for clinicians involved in virtual wards, which are a great way to do this.

NHS England’s virtual ward community of practice webinars are for anyone working in health and care with an interest in virtual wards and take place every Thursday at midday. Each week, they feature speakers who talk about different aspects or types of virtual wards such as frailty, acute respiratory illness virtual wards, technology, data and digital, and operations. Email them to join at england.virtualward@nhs.net

You can join our virtual wards network on FutureNHS (registration required) to share resources, connect with others and more. You can also attend one of our events.