Length of stay and economic sustainability of virtual ward care in a medium-sized hospital of the UK: a retrospective longitudinal study

Are virtual wards for children safe and effective? A 3-year retrospective service evaluation of an urban Hospital at Home service for children and young people

OBJECTIVE

Service evaluation of an urban 'Hospital at Home' service which provides care in patients' homes that would traditionally be delivered in the hospital setting.

DESIGN

Retrospective longitudinal review of routinely collected data recorded contemporaneously for clinical use, analysed to elicit utilisation patterns and service impact.

SETTING

A paediatric 'Hospital at Home' service delivered across two large acute hospitals, treating a total of 4427 patients across both primary and secondary care in South London from January 2018 to June 2022.

PATIENTS

Children managed by the Hospital at Home service, aged 0-16 years MAIN OUTCOME MEASURES: We describe patient outcomes and service performance including data on demographics, diagnoses, referral sources, hospital reattendances and bed day savings.

RESULTS

Over the evaluation period, 11 092 bed days were saved as a direct result of this service at a cost of 1.09-1.25 nursing contacts required per bed day. Reattendance to hospital was 11.1% over the study period, however, parent/carer-initiated reattendance resulting in hospital admission was only 2.7%.

CONCLUSION

Hospital at Home services are a policy priority for the English National Health Service because of their potential to reduce admissions to and enable early discharge from hospital. This evaluation provides insight into an urban population of children managed under Hospital at Home care and demonstrates its feasibility and effectiveness. Our novel approach to the analysis of hospital reattendance data may have the potential as a template for future performance analysis of similar services.

Economic evaluation of the Liverpool heart failure virtual ward model

BACKGROUND

A virtual ward (VW) supports patients who would otherwise need hospitalization by providing acute care, remote monitoring, investigations, and treatment at home. By March 2024, the VW programme had treated 10 950 patients across six speciality VWs, including heart failure (HF). This evaluation presents the economic assessment of the Liverpool HF VW.

METHOD AND RESULTS

A comprehensive economic cost comparison model was developed by the York Health Economics Consortium (University of York) to compare the costs of the VW to standard hospital inpatient care [standard care (SC)]. The model included direct VW costs and additional costs across the care pathway. Costs and resource use for 648 patients admitted to the HF VW were calculated for 30 days post-discharge and total cohort costs were extrapolated to a full year. Primary outcomes included costs related to length of stay, readmissions, and NHS 111 contact. The total cost for the HF VW pathway, including set-up costs, was £467 524. This results in an incremental net cost benefit of £735 512 compared with the total SC cost of £1 203 036, indicating a substantial net cost benefit of £1135 per patient per episode (PPPE). This advantage remains despite initial setup expenses and ongoing costs such as home visits, virtual consultations, point-of-care testing, and home monitoring equipment.

CONCLUSION

Our HF VW model offers a substantial net cost benefit, driven by reduced hospital stays, fewer emergency department visits, and lower readmission rates. The study highlights the importance of considering system-wide impacts and continuous monitoring of VWs as they develop.

The role of virtual wards in maternity in the United Kingdom

Virtual wards are an initiative which aims to provide hospital care from the comfort of the patient's own home. Monitoring and additional services, such as intravenous drugs and fluids and blood tests can be undertaken through this system. Although virtual wards have been used in the UK since 2005 in specialties such as General Medicine, General Surgery and Paediatrics, their use in maternity has been more limited. This article aims to review their current use in the UK and beyond as well as to discuss some of the advantages and challenges they may pose to a maternity population.

A 2-Year Retrospective Clinical Evaluation of a Novel Virtual Ward Model

OBJECTIVE

The Wrightington, Wigan, and Leigh NHS Teaching Hospitals Foundation Trust (WWL) developed a novel virtual ward (VW) service that integrated with community and primary care, supported healthcare throughout a patient's journey, and had a clinical workflow that could step-up or step-down care as needed. We described their VW and evaluated clinical outcomes, adherence, safety, and patient satisfaction.

METHODS

Retrospective, single-center study of patients admitted to the WWL VW service from January 14, 2022 to January 31, 2024. Clinical data collected by WWL in their database for patients admitted to the VW, were matched to data captured automatically by the Current Health (CH) platform linked to the CH remote monitoring kits assigned to patients on the VW. The CH kits enabled the VW care at WWL and included a wearable device for continuous vital signs monitoring, a blood pressure cuff, and tablet. Evaluation metrics included clinical scope, clinical outcomes, adherence, safety, and patient satisfaction.

RESULTS

There were 1835 admissions and a 93% match rate between the clinical and CH databases. About 38% of referrals were step-up (31% ambulatory care and 7% primary care) and 62% of referrals were step-down (100% inpatients). Most specialty referrals were from thoracic and acute medicine (77%). The median length of stay on the VW was 8 days [IQR 5-13], 209 (12%) admissions were escalated to the hospital, 179 (11%) escalated to the emergency department out of hours, and 29 (2%) signposted to urgent medical services. Adherence to the wearable device was 92%. There were 38 minor safety incidents (typically hypersensitivity reactions or administrative errors) and 17 expected deaths. About 94% of admissions rated the VW experience as "excellent" or "good." Results were similar between step-up and step-down referrals.

CONCLUSION

We have shown the VW service yielded acceptable clinical outcomes, was safe with no serious adverse events or negative impact on mortality rate. Patient adherence to the technology and satisfaction with the VW service were high. The VW service was innovative in its acceptance of a broad range of patients, expanding services beyond respiratory medicine, and in developing a step-up pathway, preventing some patients from ever taking up an acute bed in the hospital.

Evaluating and Improving Surgical Site Infection Prevention: Outcomes of a Two-Cycle Audit and Targeted Interventions in a Low-Resource Setting

Background Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs), leading to significant morbidity, mortality, and increased healthcare costs. Despite the existence of international guidelines, adherence to best practices remains inconsistent, particularly in low- and middle-income countries (LMICs).  Objective The objectives of this study are to evaluate compliance with SSI prevention guidelines among medical professionals at Kasr El Ainy Teaching Hospital in Cairo, Egypt, identify gaps in practice and knowledge, and implement targeted interventions to improve outcomes.  Methods A prospective two-cycle audit was conducted over a period of eight months involving 225 elective surgical patients and 229 healthcare providers. Questionnaires were distributed to foundation year (FY) doctors and surgical residents to assess their knowledge and practices related to SSI prevention across the preoperative, intraoperative, and postoperative phases. Patients were followed up to monitor the incidence of SSIs. Interventions implemented included educational sessions, dissemination of posters, and hands-on training to enhance adherence to best practices. Results The initial audit revealed an SSI rate of 12.6% and significant gaps in guidelines knowledge, including improper preoperative hair removal methods and prolonged postoperative antibiotic use (85.7%). Post-intervention, SSI rates decreased to 6.6%, with the questionnaire results showing marked improvements in understanding of key components in SSI prevention: 100% became aware of appropriate intraoperative surgical antibiotic prophylaxis (SAP) (compared to 72.3%), a significant increase (p < 0.05) in the use of clippers (rather than razors) for hair removal (72.1% vs. 33.7%) and intraoperative (rather than preoperative) hair removal (91.8% vs. 10%) (p < 0.05), as well as the need for intraoperative warming practices (87.7% vs. 47.7%) (p < 0.05). Knowledge and adherence to aseptic techniques improved across all staff groups, with awareness increasing from 36.3% to 81.9% among junior doctors, representing a significant improvement (p < 0.05). Conclusion Targeted interventions, including education and practice standardization, significantly reduced SSI rates and improved compliance with prevention guidelines. These findings highlight the value of structured audits and educational programs in enhancing surgical outcomes and reducing the burden of SSI, particularly in resource-limited settings.

Digital tools in heart failure: addressing unmet needs

This Series paper provides an overview of digital tools in heart failure care, encompassing screening, early diagnosis, treatment initiation and optimisation, and monitoring, and the implications these tools could have for research. The current medical environment favours the implementation of digital tools in heart failure due to rapid advancements in technology and computing power, unprecedented global connectivity, and the paradigm shift towards digitisation. Despite available effective therapies for heart failure, substantial inadequacies in managing the condition have hindered improvements in patient outcomes, particularly in low-income and middle-income countries. As digital health tools continue to evolve and exert a growing influence on both clinical care and research, establishing clinical frameworks and supportive ecosystems that enable their effective use on a global scale is crucial.