New way of health care sees more Lincolnshire patients being treated in their own homes

Lincolnshire Community Health Services NHS Trust (LCHS) can see and treat more patients, thanks to its virtual ward programme. Alongside various partners, the Trust has worked hard to create a number of virtual wards to help treat patients in the area, including cardiology and frailty patients.

A virtual ward (also known as hospital at home) allows patients to receive care and support from healthcare professionals while staying in their homes. Patients are monitored remotely, and if they need medical attention, a healthcare professional will visit them at home or arrange for them to come into hospital.

LCHS hosts the cardiology virtual ward which works on a ‘step up, step down’ model, meaning patients can either be put on a virtual ward (‘stepped down’) from hospital, or they can be ‘stepped up’ to a virtual ward from a consultation or conversation with the team. The step-up programme has allowed the team to treat patients in a personalised way, depending on the patient’s conditions and symptoms.

The step-up programme saves patients from having to go to hospital, instead allowing them to be assessed at home by specialists in the field, so they can receive the right care for them. The service operates 7 days per week, ensuring the most unstable patients have a point of contact over weekends. The ward can care for 30 patients virtually, but there are plans to expand this number in the future.

As part of the programme, ambulance and paramedic staff can also contact the team when visiting a cardiology patient on an emergency call, meaning the virtual ward team can help them make an informed decision about what is best for the patient. This can involve taking them to hospital or placing them on a virtual ward where they can have home visits from specialists, remote monitoring, or communicating with the team to help monitor their situation.

Part of the programme also allows for electronic prescribing where appropriate, so patients can stay in their homes, and still have access to the medicine they need.

There are several benefits to using a virtual ward, including improved recovery, convenience for patients able to receive the care they need from the comfort of their own home, they free up beds for patients who aren’t suited to virtual wards, and they can reduce the length of hospital stays.

The Trust also hosts a frailty virtual ward that, within its first year, had just under 500 admissions saving more than 2,000 hospital bed days. The ward looks after patients in their own homes (including care homes), providing them with the same level of expertise and care that they would receive in hospital.

Patients arrive with an acute medical episode and will stay on the virtual ward for up to 14 days. Some patients have complex needs (frailty does not specialise in one area), but with this person-centred approach, within four to five days, they are well on their way to recovery due to the rapid diagnostic skills of the ward’s consultant, and timely administration of treatment and care.

The specialist team of nurses carry out face-to-face visits to patients on an individual basis, undertaking observations and tests, providing any care needed for the patient, and offering comfort and support to their loved ones. Where possible, patients are issued with a remote monitoring kit, enabling them to take their own observations and feed these back to the team at set times throughout the day. This reduces the need for face-to-face visits where patients are stable enough for telephone support.

After visiting the patients or receiving the remote observations, specialist nurses will feed back findings or concerns at the virtual ward’s daily Multi-disciplinary Team (MDT) meetings where each patient is overseen by the consultant geriatrician. Also present at MDT meetings are representatives from other integral organisations including Lincolnshire Partnership NHS Foundation Trust, East Midlands Ambulance Service, Urgent Community Response, Occupational Therapy, Age UK, Adult Social Care, community nurses and community hospital doctors. This collaboration is of huge importance to patients; information gathering, and referrals can be carried out there and then, saving valuable time, and ensuring speedier responses to patients.

Once the acute stage or episode has been settled, patients are given a treatment plan and referred on to appropriate services such as palliative care, community nurses, adult social care, and therapy teams. They are then discharged back into the care of their GP.

Two patients who have been cared for on the frailty ward are Christine and David Barney, husband and wife from Lincolnshire, who were treated on the ward earlier in the year. About their experience they said: “The ongoing support and care we have received from all of this wonderfully dedicated team is second to none.

“The understanding, attention to detail, calming presence, and continued aftercare they give to each patient is amazing. We cannot praise them enough. I want to give my thanks to each and every one of them.”

About the Frailty Ward, Deborah Birch, Consultant Nurse for Frailty at United Lincolnshire Hospitals NHS Trust said: “The frailty virtual ward has been running in Lincolnshire for the last 18 months. During that time, as an ‘acute hospital’ nurse for the last 30 years, I have become completely converted to the belief that care in the person’s home is the absolute way forward for frail older people in so many cases. Being at home, surrounded by familiar objects, loved ones and so on, beats any hospital bed possible.

“We still have frail patients in hospital obviously, if they are really sick and need that intensive support but in lots of cases we can deliver ‘hospital’ type reviews but in their own homes.”