Hospital-level care for patients in the comfort of home

A new virtual ward in University Hospital Limerick which uses technology to provide patient care at home has saved more than 2,000 inpatient bed days since its introduction last summer.

A total of 325 patients have been cared for at the Virtual Ward since July 1st, using technology to link them with UHL for monitoring two to three times daily - and in the process freeing up 2,053 bed-days for hospital treatment of more acutely ill inpatients.

“For us, the Virtual Ward is about more than diverting patients away from the hospital—ultimately it’s about ensuring high quality care in your home, enabled by technology. This new model of care empowers our patients through increased knowledge about their health and self-management of their conditions,” said Patricia O’Gorman, Nurse and Midwifery Informatics Officer, who led the implementation of the Virtual Ward at UHL.

Patients referred from the hospital’s ED, Acute Medical Assessment Unit and medical wards receive a full technology kit, including a tablet and medical diagnostic equipment. At home, this equipment links the patient with a central hub in UHL, allowing for 24/7 monitoring. Average length of stay on the UHL Virtual Ward is 6.6 days.

For John Crowe, who lives just outside Tipperary town, approximately an hour’s drive from UHL, his recent experience of the Virtual Ward was a revelation. John, a haematology outpatient, experienced serious side-effects from medication prescribed for his treatment, with a risk of heart failure. Stabilised after a night in UHL for treatment and observation, John was deemed suitable for the Virtual Ward.

“When they told me that they would be able to monitor me from home rather than keep me in hospital, I thought it was fantastic, and my family wouldn’t have to worry about me being in hospital or having to travel in and out to visit. I was a bit concerned at first because I’d never used anything like this before. But my wife has better knowledge than I would of things computerised, so between the two of us, we were able to manage it.”

“Every morning and every evening, I’d use the tablet and the various devices linked to monitor my blood pressure, temperature, heart rate and so on. The Virtual Hub team always called me back to tell me everything was good. It was very reassuring. If there any slight issue at all, they’d call straight away and ask you to repeat it.”

“It was brilliant, so easy to use. If I had any worries, all I had to do was ring them and they would go through that monitoring process, and they could tell me what I needed to do, whether that was continued monitoring, or coming in, or needing an ambulance. Thankfully, it worked out well for me, and I was discharged from the Virtual Hub after a week.”

“A big thing was the reassurance for my wife and family. I have two sons locally, and one in Limerick, and I have brothers and a sister and they had the option to visit me at home, rather than in a hospital. It’s a great service, and it’s fantastic to know that it’s available here in the Mid West,” John said.

Jesna Jose, Clinical Nurse Manager (CNM2) on the Virtual Ward, says John’s experience is typical of many of the patients in her care. “Patients are telling us that they much prefer being treated in the comfort of their own homes rather than spending days in the hospital, and that they feel not only supported, but also better able to manage their conditions at home.”

Acute virtual wards have been pioneered in Ireland by UHL and St Vincent’s hospitals initially for patients with for cardiology and respiratory conditions. The initial success at UHL has driven expansion of the referral pathways to include patients in general medicine including flu/covid-19; minor stroke /TIA ; rehab; asthma; supplementary oxygen; and a respiratory pathway for St John’s Hospital. Discussions are ongoing to build pathways in orthopaedic post-operative knee & hip (with Croom Orthopaedic Hospital); gynaecology; and colorectal.

The Virtual Ward was implemented in collaboration with HSE National Strategic Programmes and eHealth offices, and in partnership with European virtual ward specialists Doccla.

Eight months on from implementation at UHL, anecdotal patient feedback has been secured through an evaluation facilitated by UCD. Patricia O’Gorman explained: “That study reports numerous benefits to patients, including nutrition, reduced risk of hospital-acquired infections, safe care, empowerment and increased knowledge of their conditions. The patients themselves reported feelings of safety, trust and improved self-management, while also valuing the responsiveness of our staff in the hub at UHL.”