Successful Implementation of a Virtual Ward: Service Delivery, Technology and Lessons for the Future

Like many Trusts, when Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) began setting up their virtual ward, the implementation required new staffing models, escalation processes, risk management, and information governance. Collaborating with researchers from Current Health, NNUH programme leaders seized the opportunity to document implementation lessons, which the joint team published in the British Journal of Nursing. The following is a summary of that article, titled “Successful implementation of round-the-clock care in a virtual ward during the COVID-19 pandemic.”

The virtual ward at NNUH has been very successful: admitting 852 patients in its first year of operation, providing 24/7 nursing coverage, and supported by pharmacists and junior doctors, daily consultant-led ward rounds and virtual visits.

The Virtual Ward Model

The virtual ward was established as a transfer facility for patients who would have otherwise occupied physical acute beds. The service provides the following benefits:

• safe, effective, continuous patient monitoring
• avoid hospital admissions
• facilitate early discharge
• reduce physical bed occupancy to free up much-needed hospital beds
• prevent further spread of COVID-19 disease and reduce risks for patients and staff

Operating 24/7, the virtual ward had an operational lead, a ward manager, and a team of registered nurses who provided remote care using digital health tools from Current Health. The team had access to the Trust’s clinical systems and services, enabling them to deliver comprehensive care. Current Health also provided training to ensure staff expertise in remote healthcare delivery.

The staff held a daily virtual “ward round” to review management and discharge plans. Patients received daily virtual visits via telephone or video calls, allowing for discussions on their symptoms and progress. The Current Health platform was used to monitor patients, with a wearable armband collecting continuous vital signs data. The platform also includes a web dashboard for staff to view observations and set alarms for threshold breaches. The kit provided to patients included additional monitoring devices, such as scales or blood pressure cuffs, as needed. The web dashboard displayed observations in a hospital observation chart format, and aggregated reports allowed the team to facilitate long-term progress tracking.

Overall, the virtual ward successfully facilitated the transfer of patients who required acute care, allowing them to receive remote monitoring and support. Digital health tools enabled comprehensive care delivery, ensuring patient safety and well-being. The virtual ward’s operations were closely monitored through an established virtual ward board, ensuring quality, safety, and performance. The success of the virtual ward model highlights the potential of digital health solutions to expand healthcare capabilities and provide effective care outside of traditional inpatient settings.

Implementing the Virtual Ward

The implementation of the virtual ward began with scoping, staffing, and training. Staff who were shielding were recruited to support the virtual ward remotely. The initial costs included remote working kits and an operational lead. Training for subsequent staff was conducted remotely with support from Current Health.

The virtual ward was introduced in two stages, first transferring suitable inpatients to the virtual ward and then expanding to incorporate other patient pathways. Criteria for admission included patient consent, ability to communicate and operate the equipment, and adherence to the virtual ward guidelines.

The staffing model initially supported 20 virtual beds, and later expanded to 40 beds with additional on-site nurses. Funding for the virtual ward came from COVID-19 emergency funds, winter funding, and national funding through the integrated care system.

Admission templates were designed for each pathway, outlining inclusion/exclusion criteria, alarm parameters, and escalation processes. Alarm parameters were adjusted on a per-patient basis as needed. In case of deranged vital signs, the team followed the pre-defined escalation ladder, involving nurse specialists and consultants, and arranging transfers back to the hospital.

Virtual Ward Successes, Benefits, and Lessons Learned

In its first year, the virtual ward received overwhelmingly positive feedback. All patients surveyed said they would recommend the virtual ward to others.

Many patients reported increased confidence and relief when transferred from the hospital to the virtual ward (early discharge). Even still, a few patients became anxious about being discharged from the hospital, even though they had wearable monitoring. Some patients also had frustration when they had occasional technical issues with their remote monitoring equipment.

The virtual ward simplified staffing coverage during sick leaves as replacements could work from home. Staff highlighted the benefits of working from home, including those who were shielding or had other health constraints.

Challenges included raising awareness of the virtual ward’s presence, managing differing expectations among potential users, overcoming concerns around increased workload, and transitioning from emergency to long-term funding.

Clinicians were initially wary and concerned about increased workloads, but this was addressed by demonstrating the virtual ward’s ability to provide comprehensive care and its efficient implementation. And while the virtual ward was originally intended for COVID-19 patients, it has expanded to nine other use cases.

Conclusion

The NHS virtual ward successfully provided continuous remote monitoring to 852 patients amid exceptional pressure on staff and services. Initially focused on COVID-19 cases, the virtual ward expanded to treat conditions traditionally requiring inpatient care. With plans to expand further, the virtual ward aligns with the trend of digitising healthcare.

As technology continues to advance, virtual work will become more prevalent in nursing careers. Implementing a virtual ward highlights the importance of understanding virtual healthcare’s challenges, lessons, and opportunities to ensure efficient, safe, and satisfying experiences for patients, staff, and employers.