Virtual wards and Hospitals-at-home: has their time come?
What are ‘Hospitals-at-Home’ and ‘Virtual Wards’?
Hospital-at-Home is a way of supporting patients at home who would usually be managed in a hospital.
The model includes ‘admission avoidance’, where patients are wholly managed at home, or ‘early discharge, where the latter part of the patient pathway is supported at home.
Hospital-at-Home services provide face-to-face care at home through a multidisciplinary team (MDT) based in the community. Care is designed to be ‘patient and caregiver-centered in partnership with the multidisciplinary team. Defined clinical pathways and protocols are a key feature of the model.
Virtual Wards focus more on older patients. They are generally ‘hospital-led’ and supported by technology. They enable the delivery at home of acute care, monitoring and treatment. Various combinations of remote monitoring and face-to-face care are used. The deployment of apps, technology platforms and wearable devices is a key part of the service.
Why are healthcare organisations interested in Virtual wards and Hospitals-at-Home?
In the UK, the National Health Service (NHS) has been under pressure in terms of an increase in emergency hospital admissions and difficulty discharging patients from hospitals, which has led to longer waiting times for non-urgent procedures.
A Virtual Wards program has been implemented to address this. In 2022, around a hundred thousand patients have been managed at home with ‘hospital-level’ care.
The NHS National Medical Director estimates that 20% of acute hospital admissions could be avoided through these kinds of pathways.[1] The majority of patients who have been managed through these pathways say that they ‘prefer to be supported at home rather than in hospital’.
Various case studies have demonstrated cost savings through Virtual Ward programmes, although the systematic evidence of this is as yet uncertain.[2] [3]
What kind of patients would benefit from Virtual Wards and Hospitals-at-home?
A wide variety of clinical conditions can be managed safely and effectively through Virtual Wards and Hospital-at-Home services. An audit of conditions published by one provider included: exacerbation of chronic obstructive pulmonary disease, exacerbation of congestive heart failure, dehydration, deep vein thrombosis, complex urinary tract infection, cellulitis, and community-acquired pneumonia.[4] Many other conditions are also managed in this way.
Critical to the success of these programs is the need to select patients, and their caregivers who are both clinically suitable and supportive of this model of care. In addition, the scope and organisation of the multidisciplinary care team, and communication between support services, have a significant impact on outcomes.
What should organisational leaders be thinking about with regard to Hospitals-at-Home and Virtual Wards with respect to their organisation’s future?
Although the concept of Hospitals-at-Home has been evolving over the last thirty years, the Covid-19 pandemic has broadened views about how safe and effective this system of care may be for a wide range of patients, who do not necessarily need to be managed in a hospital setting.
Developments in technologies such as remote patient monitoring, telehealth and telecare, enable 24/7 communication and monitoring. This helps support alongside multidisciplinary teams, carers and patients with timely information and alerts, which can reduce clinical risk and enhance overall care planning.
Organisational leaders who monitor key performance indicators at the Board level are interested in parameters such as patient access to care, quality of care provided, optimising use of resources, care outcomes and cost controls.
Published data shows that for the right selection of patients, Hospital-at-Home and Virtual Ward programs can have a significant impact on these indicators. Over time, as technology and home-based care models evolve, they will become a more central part of the organisations’ care provision.
In the short term, actions that organisational leaders can take now include:
Auditing hospital admissions that may have been managed more effectively through Virtual Ward and Hospital-at-Home programs.
Undertake a business planning exercise to evaluate whether a Virtual Ward and Hospital-at-Home program could provide benefit to the organisation in terms of improving KPIs.
If an outline business case is made, undertake the design, development and piloting of a small-scale Hospital-at-Home program, supported by external organisations that have the necessary experience.
In summary, the time is ‘now’ for Hospital-at-Home. In coming years, this form of care will become mainstream as knowledge, technology and outcomes evolve. Organisational leaders will be wise to invest some time and thought as to how their business may benefit.
Dr Tony Felton MBBS DRCOG MRCGP MBA, was Medical Director of Clinovia, a UK-based high-tech home healthcare company. He now works as a Consultant for GreyBeard Healthcare.
References
[1] NHS England » World-leading NHS virtual wards treat 100,000 patients in a year.pdf
[2] http://blog.hettshow.co.uk/benefits-and-challenges-of-virtual-wards#:~:text=Delivers%20cost%20savings&text=For%20example%2C%20Croydon%20Health%20Services,of%20£742.44%20per%20patient.
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9835137/pdf/afac319.pdf
[4] https://www.commonwealthfund.org/publications/case-study/2016/aug/hospital-home-model-bringing-hospital-level-care-patient
