P21 Development of a COVID-19 virtual ward to facilitate early discharge from hospital for patients with an on-going oxygen requirement

Abstract

Introduction and ObjectivesThe COVID-19 pandemic required rapid service changes in order to meet the emerging needs of our patients and to reduce pressures on hospital beds. In March 2020 we established one of the first virtual wards with the aim of supporting patients with a continuing oxygen requirement safely at home during their COVID-19 illness.MethodsThe virtual ward was delivered by the integrated care ImpACT+ service. This multi-disciplinary service comprises respiratory consultants, respiratory specialist nurses, physiotherapists, occupational therapists and fitness instructors. Our local criteria for on-boarding included: 10 days post onset of symptoms, oxygen requirement 4L or less and the ability to manage with home monitoring equipment. A mix of telephone and home contacts were offered and daily consultant MDTs undertaken. Therapy team members were up-skilled to support oxygen assessments and weaning regimes to maximise service capacity. A direct electronic referral icon was created on the hospital whiteboard system accompanied by a nurse-led telephone referral service. The scheme was advertised through posters and in-reach work into COVID-19 areas.Results107 patients were managed on our virtual ward since March 2020. This included 99 COVID-19 patients and 8 with other acute respiratory exacerbations. The mean continuous oxygen prescription on discharge was 1.5 L (range 0.5–4L) and for ambulatory purposes 2.4L (1–6L). 55 patients with COVID-19 were discharged on anticoagulation, 33 on steroids and 21 on antibiotics. 8 30-day readmissions, 3 deaths (2 expected). The total number of bed days on the virtual ward was 2010 (mean 21 days) and in total the activity that service delivered included 904 telephone calls and 274 home visits. Service feedback demonstrated a high level of satisfaction with patients commenting that they valued being at home with support during their recovery.ConclusionsThis service has shown a supported discharge Covid-19 oxygen weaning service is a valuable initiative to relieve pressures on the acute hospital service and provide high quality care to facilitate early discharge from hospital. This virtual ward highlighted the value of having an integrated respiratory team and extension of this model to other respiratory conditions should be possible with considered adaptions.