The success of St Rocco’s Palliative Virtual Ward
23 September 2024
Since April 2022 the team at St Rocco’s Hospice in Warrington, in collaboration with its partners Warrington and Halton Hospital and community teams worked with remote monitoring experts Graphnet to develop and implement an innovative Palliative Virtual Ward (PVW). This initiative aims to provide people with a palliative diagnosis the best quality of life at home for as long as possible. The results have been overwhelmingly positive, with patients and their families expressing immense satisfaction with the services provided.
Overview of the Palliative Virtual Ward
The PVW was established to address the need for better management of palliative patients, who were often subjected to inappropriate hospital admissions and prolonged stays that could detract from their final days at home. Aligning with NHS England’s ambition for virtual care, St Rocco’s Palliative Virtual Ward enables patients to remain in the comfort of their homes while receiving the necessary medical support. This model was the first of its kind in the UK, serving as a pilot project that has since inspired similar initiatives nationwide.
Exceptional patient feedback
The management team at St Rocco’s commissioned Healthwatch Warrington to impartially review the data from a survey sent to patients and their families. The aim was to assess performance, identify successes, and highlight areas for improvement.
Over the past 12 months, St Rocco’s has supported 147 patients and their loved ones, helping them to stay at home and receive care. Of these, 90 were unique patients. The hospice virtual ward team made direct contact with patients and their families, and the survey was also shared on social media platforms. A total of 39 surveys were completed, resulting in a 43% response rate.
Patient feedback has been exceptionally positive, showcasing the high standards of care and support provided by the PVW. Key statistics highlight this success:
• 97% of patients would recommend the PVW to family and friends.
• 90% of those asked felt that their condition had been better managed by the PVW (10% n/a)
One family member remarked:
My mum received outstanding care from the Virtual ward. It alleviated so many of our concerns without visits or just to reassure her.
Another commented:
The daily calls were always great and always felt supported.
The role of remote monitoring
A significant contributor to the PVW’s success is the involvement of Graphnet, a leader in remote monitoring technology with their Docobo Remote Monitoring. The solution has proven instrumental in providing seamless, real-time monitoring of patients’ conditions, ensuring timely interventions and personalised care.
A patient said:
The provision of the system allowed real-time events to be uploaded, providing a full overview
of my condition. The daily follow-up call by the team enabled me to discuss any further concerns and receive appropriate guidance as required. Overall, this also assisted with my anxiety.
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 of the Palliative Virtual Ward
The PVW offers numerous benefits, both for patients and the healthcare system:
- Early Supported Discharge: facilitates quicker discharge from hospitals, allowing patients to spend more time at home.
- Admission Avoidance: reduces unnecessary hospital admissions, particularly in the last days of life.
- Personalised Care: ensures that care is tailored to the individual needs of patients, respecting their preferences and priorities.
- Enhanced Patient Experience: patients and their families report feeling more involved and supported, leading to improved mental well-being and quality of life
A family member shared:
Having the virtual ward gave me a lot of reassurance that I was doing all I could for my husband. Their advice helped me in decision-making, and I was also supported when I struggled myself. This is invaluable for mental wellbeing.
The Palliative Virtual Ward at St Rocco’s Hospice has set a benchmark for palliative care, combining compassionate, personalised care with innovative technology. The overwhelmingly positive feedback
from patients and their families underscores the PVW’s success in improving the quality of life for those with palliative diagnoses.
As one family member succinctly put it:
The hospice could not do enough for my dad and was also a great support to our family.
Dr Esraa Sulaivany, Medical Director, St. Rocco’s Hospice says:
The Palliative Virtual Ward has provided St Rocco’s with an opportunity to work closely with our partners so that we can offer more choice to patients. We have expanded our service to support a wider cohort of patients without compromising on quality of care, better triaging potential patients and monitoring changes in symptoms through the use of technology. Feedback shows that 90% of the patients cared for agreed that their condition was managed better because by our Palliative Virtual Ward. This is testament to the hard work and dedication of our clinical teams
to adapt to a new way of working whilst always prioritising patient care and individual needs.
In addition, we have been able to better involve families and carers in patient care plans. This is another of the many highlights shown in the Healthwatch Warrington independent report as 94% agreed that their family/carer benefited from the Palliative Virtual Ward. As we move forward, integrating technology with care services is beneficial to many people and I am pleased that St Rocco’s has had the opportunity to explore this initiative with the support of Graphnet.
Sara-Marie Black, Chief Operating Officer, St. Rocco’s Hospice says:
Independent evaluation by Healthwatch Warrington provided an opportunity for impartial feedback and areas for improvement to be identified. It is a privilege to work with such an amazing clinical team within the hospice and health and social care partners. The evaluation and positive patient feedback is a reflection on the clinical team’s ideas for new ways of working and dedication to deliver high quality, sustainable care.
The IHospices nationally are currently struggling with projected deficits and risk of future sustainability. The virtual ward provides a different model of care, offering choice for patients and those important to them and a different financial model. With continued partnership working, the virtual ward offers a supplementary service to enhance care for patients and our community. Areas for improvement and learning were also identified as part of the independent review and the team, working closely with Graphnet and partners, are supporting further development of the virtual ward.
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. With continued collaboration and refinement, the PVW model promises to enhance palliative care services further, ensuring that patients can spend their final days with dignity and comfort in the familiar surroundings of their homes.
