Community Palliative Virtual Ward, St Rocco’s, Warrington

The Warrington Palliative Virtual Ward pilot commenced in April 2022 and was the first national community Palliative Virtual Ward. This programme is aligned with NHS England’s national ambition for Integrated Care Systems to work towards the comprehensive development of virtual ward beds.

The problem

Palliative patients were being inappropriately admitted to acute settings, with long hospital admissions impacting upon patients last 90 days of life and time at home.

The solution

The team at St Rocco’s Hospice in Warrington, Warrington and Halton Hospital and community teams worked with our remote monitoring experts to develop a Palliative Virtual Ward (PVW). The team successfully bid to develop a 10 bedded PVW offering support through a 14-day plan of care. This was designed to offer additional support to palliative patients at home and to help prevent hospital admission. The feedback from patients and families has been excellent. Development of plans of care used as part of the digital monitoring technology, aligned to the IPOS (Integrated Palliative care Outcome Scale). IPOS is a measure of symptoms and concerns which matter to a patient and helps us provide the best care.

Successful pilot phase

The team carried out a 12-month pilot on the development of the Nurse Led Palliative Virtual Ward from April 2022 – March 2023 and successfully implemented a 10 bed Palliative Virtual Ward. Despite challenges due to system pressures, medical and advanced nurse capacity, and demand the palliative virtual ward supported patients to remain at home. The publication of National Palliative Virtual Ward Guidance helped shape the project and a further 12-month funding was received from ICS (Warrington Place) to develop Consultant led and medical oversight model, aligned to National Guidance for Palliative Virtual Ward. Further development of the model now includes consultant oversight and medical input from the medical team within the hospice

What happens when someone is referred to the Palliative Virtual Ward?

Patient cohorts are chosen in line with the National Palliative Virtual Ward Guidance, to include those who are clinically unstable, those who would otherwise have to be in an inpatient hospital or hospice bed; those who would benefit from daily remote symptom monitoring and those whose expected required time for the service is short term – i.e. up to 14 days.

Palliative patients are then referred via the Integrated Palliative Care Hub, with an initial face to face clinical holistic assessment at home or in a ward setting.

This takes into account clinical management decisions such as the possibility of intensifying treatment at home. It also takes into consideration the person’s wishes and the safety of the person and their family and carers and also the families’ or carers’ ability to provide support.

Once on the virtual ward, using Docobo Remote Monitoring technology, patients record a daily review of every person on the virtual ward. This may be face-to-face, virtual (video) or via telephone contact, depending on the patient’s condition and ability to engage with the service.

The Virtual Ward team involved in the patient’s care recognise early signs of deterioration and fully understand the intervention and escalation processes. Suitable arrangements are made for transferring care from the Virtual Ward to other services, suitable for a person’s needs, e.g. to primary care, community specialist support and third sector from a clinical nurse specialist, Community services including District Nursing teams, Urgent Community response and social care for Palliative and End of Life Care.

Benefits and outcomes

• Step up/ Step down model complimenting existing service.
• Early supported discharge.
• Reduced patient anxiety following long length of stay.
• Hospital/ Hospice avoidance enabling patients to have time back with their families.
• Medication optimization and management of symptoms promptly evaluated.
• Patient and families choice supported by early response and assessment.
• Earlier assessment to enable improved triage for admission into hospice beds.
• Sustainability of hospice model – a different way of working/ thinking

Feedback

A Palliative Virtual Ward patient said:

Support was excellent via telephone and text. I was telephoned every day for a week and it was comforting to know that there was someone there to help and support.

Dr Esraa Sulaivany, Medical Director, St. Rocco’s Hospice says:

We are now better integrated with all palliative care services, as the Palliative Virtual Ward gives the patients and their families the confidence to go home and stay at home, so they feel safer and connected. It allowed us to actively monitor our patients and medically intervene when needed and enabled us to provide safer care at patients own home.

Sara-Marie Black, Chief Operating Officer, St. Rocco’s Hospice says:

The Palliative Virtual Ward has provided a supplementary service to support patients living with a palliative diagnosis and those important to them. Through the use of advanced digital technology we have been able to support an increased numbers of patients and families to enable their loved ones to remain at home. The Virtual Ward team have shown great dedication and support in developing innovative ways of working to support our patients and those important to them. We have had the opportunity to share our learning with our patients, community and wider partners to continually enhance our care delivery and ensure we are at the forefront of enhancing high quality care.

A Consultant in Palliative Care, Warrington & Halton Teaching Hospitals NHS Foundation Trust says:

Changes in symptom management plans can be promptly evaluated and changed as symptoms evolve, which can help bridge the gaps between palliative medicine outpatient appointments. Patients’ and families’ preferences are more likely to be met and they are more involved in plans for their care. We can better triage who would most benefit from previous hospice beds and bring people in when needed in a timely fashion. We are more likely to be able to support the patient to stay at home and reduce the need for them to come into the hospice or the hospital.