With hospital services caring for people who are very unwell with COVID-19, healthcare professionals have learned a great deal about this illness very rapidly and now have a good awareness of who is at risk of becoming severely unwell and could benefit from early treatments.
Gloucestershire is supporting many patients at home with the expansion of COVID-19 Virtual Wards, to identify those who might need hospital assessment or admission for treatment.
Around one in 20 people with COVID infection will need hospital treatment, and many of these become severely unwell.
The main concern is that some patients with COVID-19 are often unaware of how sick they are, due to a phenomenon of silent hypoxia (i.e. not enough oxygen making it to cells and tissues in the body) where people often do not show the usual symptoms of breathlessness or wheeze.
Silent hypoxia can lead to life threatening complications for patients and it is becoming clear that there are benefits to early intervention. The COVID Virtual Ward provides a service where a patient’s oxygen saturations are recorded at home using a Pulse Oximeter and when monitored this helps to identify early warning signs, allowing for earlier intervention and improved outcomes.
Patients are asked to send their oxygen levels twice daily via an app to a clinical team on the COVID Virtual Ward who review all patients’ readings and act or escalate accordingly.
The overall aim is to ensure that patients whose oxygen levels are falling, even if they show no outward symptoms, are identified and can access treatment swiftly.
Patients can be referred into the COVID virtual ward via many routes including their GP, A&E or on discharge from hospital wards such as maternity. The ward is also actively supporting staff to monitor patients in care and residential homes.
Dr Charles Sharp, Respiratory Consultant at Gloucestershire Hospitals NHS Foundation Trust, said: “Since the start of the pandemic, the NHS has been adapting the ways in which it supports patients to minimise the transmission of COVID-19, for example, through using online or telephone consultations with GPs, consultants and other health professionals.
Virtual Wards are another important way to help hospitals to continue to provide high quality care to patients who are very unwell by allowing clinicians to safely manage and monitor patients at home and identify those who need to be in hospital.
They support people to receive care that meets their needs promptly, and hopefully give people confidence that they can remain at home safely.
People can either be added to the Virtual Ward list as they leave hospital to return home or can be added by other healthcare professionals working in the community when they are identified as requiring additional support. It is vital that people who have symptoms of COVID get tested so that we are able to monitor them safely.”
The service is supported by telehealth provider Baywater Healthcare, which helps patients who do have access to technology or need help using it. G DOC, the county’s GP provider company, provides clinical oversight of the service seven days per week, ensuring that patients are receiving timely and compassionate care.
Dr Jo Bayley, Chief Executive of G DOC, said: “The Virtual Ward scheme is really helping us to transform the way we care for people who have COVID. We know that people often recover best in their own home, but getting a diagnosis of COVID can feel frightening, especially for people who live alone. The virtual ward allows us to support people recovering at home; they feel reassured that help is available if they need it.
Patients have been telling us how much they value the Virtual Ward service as it gives them peace of mind, knowing that we are working with, and supporting them, to keep safe. And, if patients do become more unwell, we can ensure that they get the help they need quickly.”
Dr Hein Le Roux, Deputy Clinical Chair at NHS Gloucestershire Clinical Commissioning Group, said: “The idea behind the Virtual Ward is that it acts as a safety net for patients. It helps them to feel confident about staying at home safely, knowing that if their symptoms change or become worrying, they can get support by making a phone call.
Caring for patients recovering from COVID-19 at home really can save lives. Obviously it supports social distancing and is helping our already stretched hospital doctors and nurses to focus on the most poorly patients in hospital.”
Adam Sullivan, CEO Baywater Healthcare, said: “Baywater Healthcare has been providing telehealth monitoring services in the home to patients across Gloucestershire on behalf of the NHS for several years. The mobilisation of the Virtual Ward has utilised our technology and expertise to actively support the COVID-19 challenge in the region.”
Dr Malcolm Gerald, a local GP who helped to set up the Gloucestershire service, said: “Thanks to clinicians pulling together and setting up this service in a short space of time, we have already supported over 1,000 patients to stay at home – a tremendous achievement.
Not only do Virtual Wards help to avoid hospitals being overwhelmed, but by keeping people with COVID-19 out of hospital if they do not need to be there, patients are also less anxious.”