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Are virtual wards the key to clearing the elective care backlog?

Elective care planning requires clinical and operational capacity to be aligned with demand. Whilst ineffective workforce and theatre planning can impact a trust’s ability to maximise capacity, hospital bed availability is also significantly impacting the flow of patients through elective care pathways.

Freeing up hospital beds

Delayed transfers of care (DTOCs) have long been a problem for the NHS with an estimated 1 million ‘lost bed days’ per annum at an average cost of £640,000 per day or £27,000 per hour. Beyond the financial impact, DTOCs can negatively impact on patient experience, increase the risk of infection and in some cases can increase the chances of readmission.

Effective and proactive discharge planning to reduce DTOCs provides the opportunity for NHS trusts to free up hospital beds quicker so that more patients can be admitted to receive elective care. But many ‘medically fit’ patients discharged from hospital still require wrap around care to aid their recovery.

The most recent Health and Social Care Select Committee (HSCSC) report (published 14 December 2021), highlighted the importance of tackling the elective care backlog in a ‘truly integrated way’, focusing on the interdependency between the NHS and a robust social care system to support effective discharge. The report also calls for the extension of recovery plans beyond the elective backlog, to ‘embrace a range of indicators to demonstrate that hidden backlogs are also being tackled’.

One measure to facilitate effective discharge is virtual wards.

What are virtual wards?

Virtual wards is the NHS term used for patients receiving care in the comfort of their own home (or home setting), rather than being in hospital.  Whilst the term ‘virtual wards’ has only recently been coined, the principles of running a virtual ward have been in place for some time; and with the pandemic expediting the adoption of remote care, it has forced a more joined up approach to its delivery.

A patient can be discharged to a virtual ward when they are deemed ‘medically fit’ – in some instances, this may be earlier than they would have originally been discharged because they are able to access a care package that caters for their specific needs in their own home.

The concept of virtual wards requires a collaborative approach between multidisciplinary teams to provide a combination of remote monitoring, face-to-face (community) care and the availability of specialist input where required.

Virtual wards are designed to ease pressures on hospitals and have been used extensively throughout the pandemic; in one trust, saving nearly 300 bed days over a three week period at the height of the covid-19 outbreak

The role of technology in running a virtual ward

There’s no doubt that technology plays a pivotal role in driving the collaborative approach required to run virtual wards; from the collection of patient health data using wearables and remote monitoring devices to communication between multidisciplinary teams.

But virtual wards can only support the elective care backlog if they enable secondary care teams to utilise the freed-up capacity and capitalise on opportunities to create greater efficiencies on an ongoing basis.

It is critical that NHS organisations collect data to help them measure the performance of virtual wards and establish their effectiveness. This will help trusts amplify what is working well and put a stop to less effective processes quicker. On top of those reported outcomes metrics of re-admissions, infection rates and other qualitative measures such as patient satisfaction, data collection could include:

• – Capacity monitoring to establish the impact of freeing up beds sooner
• – Productivity gains realised from increased capacity
• – Gradual reduction of patient treatment lists (PTLs) over time

 

Much of this data collection can be automated from various sources and presented via data dashboards that can be accessed in real-time. It can facilitate rapid and objective data-driven decision-making to support the continuous improvement of elective care pathways and the role that virtual wards play in them.

Conclusion

As one component of the NHS recovery plan, virtual wards have the potential to free up critical time and resources that will support a more efficient flow of patients through elective care pathways.

But we must recognise that virtual wards are only one component of a much wider strategy to tackle the elective care backlog.

As an ongoing programme of works, NHS trusts must look to all areas of their clinical and operational performance to find opportunities for optimisation.

About Four Eyes Insight

We use the combined power of people, data and technology to get to the root cause of NHS elective care pathway inefficiencies; working collaboratively and engaging with all stakeholders to get buy in for change from the ground up. We implement interventions that optimise elective care pathways and provide tools to monitor their effectiveness ensuring that a culture of continuous improvement to drive long term, sustainable change is embedded along the way.

If you would like to find out more or discuss your requirements, please email info@foureyesinsight.com