Building Remote Care Programmes Across ICSs

Norfolk and Norwich University Hospitals NHS Trust (NNUH) has pioneered a premier virtual ward program, effectively extending its reach across the integrated care system. Several leaders from NNUH joined a panel conversation as part of the Healthcare Excellence Through Technology (HETT) webinar series. This blog provides an overview of the strategy and technology the NNUH team discussed as part of that panel. Keep reading for the highlights about how they enabled the expansion of their virtual ward program to a system-wide, 24/7 service that supports multiple patient groups across the organization.

Panel participants also share NNUH’s ambitions for expanding the reach of their service via a virtual hospital, supporting both acute and chronic health conditions and enabling smooth care transitions across the integrated care system. 

Listen to the Full Conversation→

The NNUH Remote Care Programme

NNUH began exploring remote care in March 2020, as a way to reduce staff time needed to care for patients. They purchased kits from Current Health and did a pilot with their home service, which bridges the gap between the hospital and the community. They quickly recognized the value remote care could have and began to identify opportunities for expansion. 

When the initial work group reached out to staff to help them kick off the program, they received more applications than they needed. Participants who were selected received training virtually through Current Health, and had access to the dashboard, allowing them to monitor patients from anywhere. 

By January 2021, the team began setting up a virtual ward at NNUH to support COVID-19 patients. Because of the knowledge they had gained over the previous year, they were able to start admitting the first patients into the ward just three weeks later. 

Since their February 2021 launch, 240 patients have been admitted to NNUH’s virtual ward, equating to 1,807 bed days. “That would be physical bed days that they would have ordinarily been in an acute bed,” explained panelist Emily Wells, Chief Nursing Informatics Officer (CNIO) at NNUH. To date, the program has received more than 96% positive patient feedback.

Overcoming Resistance

Panelists emphasized there was strong support throughout the organization, however, a few clinical departments did have some concerns that needed to be addressed.

Several panelists gave insight into how they overcame resistance:

• Dr. Mark Pasteur, Virtual Ward Clinical Lead at NNUH, explained that, as a starting point, they intentionally sought out groups and individuals who were already enthusiastic with the idea of remote monitoring.
• Dr. Luke Evans, an Emergency General Surgeon and Consultant for the project emphasized the importance of starting small, which allowed more buy-in as those who might be resistant were able to see how well remote monitoring was working in other areas. 
• Samantha Sparrow, an NNUH Pharmacist, pointed out that it was important to consider different clinical specialities and know that the approach may need to be different, depending on the speciality. Some will be quicker to adapt, other areas, such as cardiology, have patients with more complex needs, and it can take longer to convert.

But probably the biggest help in overcoming resistance were the patients themselves—they thrived, as evidenced by the 96% satisfaction rate. “When you actually discuss that choice [remote care] with the patients, they leap at it.” said Johnny Wells, Virtual Ward Coordinator at NNUH.

Lessons Learned for Virtual Ward

“Working alongside our diagnostic and therapy teams, we learn every single week that there’s more we can do virtually than we imagined,” said Johnny Wells. The care interactions that are working well in their remote program include: 

• Provisioning supplementary oxygen for acute respiratory illness
• Monitoring complex antibiotic therapy
• Monitoring illnesses, such as osteomyelitis, nephrotic syndrome and diabetes

He added that establishing good links and between specialties was critical as well as embedding pharmacy into the virtual ward.

Benefits for Staff Wellbeing

Regarding staff wellbeing, not a single staff member has taken a sick day since they launched the virtual ward. “It’s been overwhelmingly positive because they actually get to spend more time with their patients. They manage their day,” said Emily Wells.

Looking Into the Future

The team at NNUH  are gathering data and building a business case for increasing their program. In comparison to a physical bed, they have been able to demonstrate that the virtual ward is significantly more cost-effective. “It’s 82% cheaper than a physical bed to have a patient on a virtual ward,” said CNIO Wells. With that, NNUH hopes to expand the reach of their service via a virtual hospital, supporting patients from all care settings within their integrated care system.