Meet Joanne Edwards

Virtual Wards Team Leader at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

“I’ve been working on virtual wards (also known as Hospital at Home) for about a year. Before this, I spent 20 years as a clinical manager in patient flow – so I know nearly every nurse and consultant.

Initially, we were doing Covid oximetry, carrying out basic monitoring and assessing patients daily while they were at home. We started to see the benefits of keeping people out of hospital, so we extended it into pathways, starting with respiratory. We now care for patients with conditions including respiratory, cardiology, sepsis and others.

Patients wear an armband at home that measures things like their oxygen levels, heart rate, temperature, how active they are, and even whether they’ve had a fall. Before the patient goes home, we set them up and show them how to use the equipment. We show them and their relatives exactly what they need to do and do a test call with nurses in our hub so they can see if they do need to call, a member of the team will pick up. We then arrange a time to call them the next day to check in.

If someone is struggling to use the equipment at home, one of our nurses will go out. Back in the hospital, we monitor the patient from 8am to 8pm. Patient observations are automatically captured every 15 minutes. If an observation comes up red, we ring or video call the patient and intervene if necessary. A lot of the time it’s a matter of reassuring them, sometimes we’ll implement medication, and, if needed, we will escalate.

We do actually feel like we’re on a hospital ward. We have a handover in the morning, everyone is given their allocated patients and, for continuity, the same colleague checks in with the same patient. There’s a designated helpline patients and relatives can ring which comes straight through to us.

We get lots of calls from the families, and it’s just so nice to be able to put things in place for them. It’s important patients have support at home from relatives and carers, but we’ve found relatives love that their loved ones are at home – they’re safe, they can visit whenever they want. It’s so much better.

This service is very patient-centred. When you call the patient, you can actually see they’re so much better and happier, you can hear it in their voices. They also tell you so much more when they’re at home – there’s more privacy. For example, some patients won’t tell you they’ve been having issues with their bowels when they’re on a busy ward with just a curtain around them.

Everyone loves being on a virtual ward. We love it. The patients love it. Their families love it. You get such good vibes from everyone seeing patients are so much happier back home. They’ve got their families, their pets, they eat and drink when they want to, their mental health is so much better. They can do what they want, when they want. And it’s so much quieter than on a hospital ward.

We’ve been getting excellent feedback. Patients feel so much more confident, especially knowing if they ring us, we will pick up and help. It also takes the
pressure off families having to make any decisions, when they know they can ring us.”

Tania's story

Hospital at Home (virtual wards) patient in 2022

I have a number of long-term conditions, one of which is bronchiectasis. When I was referred to Hospital at Home (virtual wards) they said it would be for two weeks. I asked ‘what exactly is going to happen?’. They said you will go home and we will arrange a time for a nurse to phone you every day. They will talk to you about your symptoms and any questions you may have. I just thought ‘wow – that’s pretty good’.

I took my sats (oxygen saturation) each day and they’d ask for my temperature. It was really reassuring and comforting; I felt the security of knowing someone was at the end of the phone. Without Hospital at Home (virtual wards), I think they probably would have kept me in hospital to monitor me.

If someone asked me whether they should use this service, I would say ‘go ahead’. You don’t have to wait for visits, you don’t have to wait for a doctor. There’s no anxiety; it is very calming; you’re familiar with everything around you. Being able to use my own shower, wash my hair in my own bathroom, it just made such a difference – it all contributes to you getting better.

At one point, the nurse said she wanted me to talk to the doctor as my symptoms had got worse. Within 15 minutes of putting down the phone, the doctor called. She said if I followed her advice and increased my steroids, I was safe enough to continue at home; it was amazing. In the past when I have been in hospital, as I’ve neared the end of my stay I have felt ok and then when I have come home I have felt insecure and anxious and a little bit frightened of coming home. It’s like a culture shock coming back home and learning to readjust. With this service, you don’t get that culture shock because you’re already home.”

Meet Karl Guttormsen

Interim Virtual Ward Lead at North Manchester General Hospital

There is no place like home; everybody wants to be at home, nobody wants to be in hospital.

I act as a medical concierge. We check in with patients every day. They are my patient, I’m responsible for their care while they’re on my ward. The feedback from patients has been they feel looked after, they feel safe. Being at home, surrounded by familiar things, really benefits patients; particularly if they have conditions like dementia or are immuno-compromised. The risk of infection is much less likely in their own environment; it’s a much safer place to be.

The virtual ward (also known as Hospital at Home) offers that bridge when people are sick enough to be in hospital and need hospital monitoring, but are actually stable enough to be in their own home. We provide wraparound care. If they do feel unwell, we can adjust medication, start new medication, or we can call in our crisis response team to visit them at home and see if they need further intervention.

We give people tech to help us monitor them. One of the bits of kit is a medical grade monitoring device which they wear. It gives us their heart rate, oxygen saturation, skin temperature, tells us how much they’re moving and their respiratory rate. We look at trends which allows us to spot how things are progressing. If something is happening only occasionally it helps us pick up on things that might have otherwise been missed.

We can also give people a blood pressure cuff and weighing scales, if needed. These are all Bluetooth and Wi-Fi enabled and connect to a tablet and a modem which provides free Wi-Fi. They only have to charge their wearable for half an hour a day and we ask them to tell us when they’re not wearing it, so we don’t worry about them!

Patients have told us they feel reassured that we’re managing their health conditions rigorously. I had a patient the other day whose blood pressure had shot up. I rang him because I’d been alerted of the change, and he was reassured to see we were monitoring him so closely. We’ve had people who have needed to be escalated; they have gone into our ambulatory care unit, been seen quickly and then sent home, and that has prevented another hospital admission.

We had a patient with non-curable cancer who also had atrial fibrillation who we managed to keep at home. Keeping him at home with his loved ones
for as much time as possible, providing wraparound care, massively improved his quality of life.

We had a patient who was 101. The risk of someone that age going into hospital is massive, but we supported them to be in their own home and stay there safely. This service provides a safety net where the person is reassured and the clinician is reassured the patient is getting the care they need, in the right place, at the right time.

This has the potential to personalise care for patients, and to improve the patient journey like no other service we could possibly deliver in a face-to-face environment.

I think the benefits for the patient far outweigh the gains for us as a health service, and the gains are huge there too. It is reduced bed days, reduced hospital acquired infections and admission avoidance, but more than all that, it is much, much better for the patient.”

Meet Stephanie Smith

Team Leader for Digital Health – Senior Clinical Nurse Assessor, Tameside and Stockport

My background is in critical care, I worked on an ITU for eight years. Our job is hospital avoidance – keeping people at home where we can.

Our staff go around the wards to see if there’s anyone suitable for the service, we attend bed meetings, we get direct referrals from wards, from crisis teams, or from A&E.

We have a full referral process; we do some checks around how comfortable people are using the equipment and discuss their home circumstances. A clinician assesses them face-to-face to check they’re suitable. Even someone with dementia, for instance, is perfectly suitable for this service as long as they’ve got support from relatives or people who will help. We have a consent document we go through with them that they sign.

We have had people say no, it’s not for them, but we’ve had lots of people say ‘yes please get me home’. We have a team that can go out and help people if they have teething problems with the equipment, for example.

Everyone prefers being in their own home, they are avoiding unnecessary infections and keeping their independence. For most people, they’re much better off in their own home rather than losing that in hospital.

It is about not losing that quality of life. We’ve had young people on the service; being on this service has meant they’ve been able to continue working, with us keeping a close eye on them.

To begin with, it was difficult to choose the right patient; you don’t know how they’re going to be when they get home. We were cautious at first, but we are so intensely monitoring them, morning, midday, mid-evening and at night. Should they come into trouble, they can get hold of us.

I think GPs were a bit unsure to begin with, but now they love the service.

We’ve had good feedback from patients. They’ve said they felt supported on discharge; they’ve found it really helpful. They have said they feel safe.

It can be nerve-wracking going home from hospital, even if you’re completely well. But with this service, going home with our support has felt like a buffer for people.”

Meet Zena Greenhalgh

Matron of the Digital Service at Tameside and Glossop Integrated Care NHS Foundation Trust

I’ve worked for digital health for six years, and virtual wards (also known as Hospital at Home) is just one of many services within digital health. Before this, I was a district nurse, keeping people out of hospital and looking after them at home.

One patient’s needs will be very different from another, so each patient has personalised care which is best suited to them.

When bringing a patient into the service, we would check if they’re suitable, show them the home monitoring equipment and make sure they’re comfortable using it. When patients go home with the equipment, one of our staff can also go out to their home and help them set up.

The digital health teams are all linked together, and we have a mix of acute and community healthcare professionals on the team. All our staff are experienced, and we use this clinical expertise when monitoring and keeping people safe at home.

We will notice the soft, subtle signs if a patient starts changing, and if we do need to bring them into hospital, we can organise a planned admission with the medics, rather than going through A&E.

This service doesn’t only facilitate daily discharge and bed saving days, it facilitates better patient outcomes. Patients are back home; they have access to healthcare professionals seven days a week, they can pick up the phone and speak to a member of staff who will make sure they are ok.

I had a patient who had a chest drain in situ, and she was in hospital for four weeks being monitored. Rather than staying in hospital even longer, we were able to get her back home and monitor her from there. That’s the beauty of this service. She was back in her own bed with her own family and her own surroundings, all whilst being closely monitored by the team.

I would say to my clinical colleagues; believe in it. Get patients back home where they are monitored and supported. Let them keep their independence. Seeing is believing, and we are seeing through this service that our patients are doing really well.”

Richard's story

Hospital at Home (virtual wards) patient in 2023

Lives in Bolton; Used the Hospital at Home (virtual wards) service in early 2023

“I had a cardiac arrest following a heart attack and I needed to go into hospital. When I was ready to be discharged the hospital needed to continue to monitor how I was getting on. I was lying in hospital connected to the machines and that was all I was doing, there was no treatment needed, they just needed to keep an eye on me.

They asked if I wanted to go home and take part in the virtual wards scheme, they described what it entailed, and I was more than happy to. I’d rather be lying in bed at home than in bed at hospital.

I was handed a band to wear on my arm and the monitoring took care of everything. It was just like wearing a watch. Occasionally I would need blood tests so a couple of nurses would still visit me to make sure I was alright.

You’ve got your home life available to you, you’re fully mobile and you don’t have to stay in. I could continue to go out to the shops and the bakery, you can live your life as normal. You can have visitors when you want, without having to stick to the hospital visiting hours.

If you’re eligible to take part, I would say go for it. It’s ideal, it gets you out and away from the hospital environment into your home life where you are happier, and more relaxed and settled.”

Richard’s wife, Hazel, said:

It was lovely to have Richard at home and to still be within his company. It made such a difference for me not having to travel into the hospital to visit, it meant we could continue life as normal. Life didn’t change and it was nice and comfortable to be at home.”

Watch their story here.