The implementation of a virtual ward using digital solutions informing community clinicians in early supported discharge of patients with SARS-Cov2 respiratory symptoms from an acute hospital setting

  1. J Swift
  2. Z Harris
  3. A Woodward
  4. NI O’Kelly
  5. C Barker
  6. S Ghosh

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Abstract

Objectives

To assess the short run successes and challenges of the implementation of a digitally supported accelerated acute hospital discharge scheme for patients admitted with Covid-19.

Design

Analysis of the safety, resource use and health outcomes within the virtual service for the first 65 patients that have been discharged from a virtual respiratory ward.

Setting

Community based intervention using digital technology and a multi-disciplinary team of specialist clinicians to monitor patients at home.

Participants

65 patients discharged from hospital followed until discharge from the virtual ward.

Results

24.6% of 65 patients had symptoms that were coded red (urgent response required) in CliniTouch Vie in the first day after hospital discharge falling to 7.7% on their final day on the virtual ward; p=0.049. Reductions in red days decreased significantly over time, from 33.8% of patients in their first three days to 10.8% in their final three days; all patients p=0.002. Four patients were re-admitted to hospital, all for clotting disorders. There was one death within this group, which following senior clinical review was deemed to be unrelated to infection with Covid-19.

The most important gain for Glenfield hospital was in expediting the rapid discharge of patients admitted with Covid-19 into a supported environment and the freeing up of beds. On 15 th January, 48% of beds were taken up with patients admitted with Covid-19 symptoms.

In November 2020, immediately prior to the launch of the virtual ward, the mean length of stay for patients who did not access high dependency care or oxygen was 5.5 (+/-1.3) days. The mean length of stay in patients discharged into the virtual ward thereafter was 3.3 (+/-0.4) days; relative reduction, 40.3% (p<0.001).

The cost of care provision in the virtual ward was 8,662 UK Pounds in total and 133.26 UK pounds per patient. The estimated overall savings were 68,052 UK Pounds and the mean saving per patient was estimated at £1,047 UK Pounds.

Conclusions

The virtual ward appeared to assist with earlier discharges, had a low rate of clinically necessary re-admissions, the safety of patients was not compromised and whilst cost savings were not the primary objective, it seemed to also reduce overall resource use and costs.

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  1. Version published to 10.1101/2021.03.29.21254548v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2021.03.29.21254548: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisWhilst statistical methods have been employed to determine the validity of the initial findings, many endpoints were not pre-specified, no estimate of effects pre-determined, no power calculations made and all data analysed were observational.
    Sex as a biological variable39% of patients were female and no ethnicity data were retained.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    These data were extracted from the CliniTouch database and analysed in Microsoft Excel 365 Data Analysis pack.
    CliniTouch
    suggested: None
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.03.29.21254548v1 on medRxiv