Outcomes from a virtual ward delivering oxygen at home for patients recovering from COVID-19: a real world observational study

Ward, Tom; Mavilakandy, Akash; Danns, Julie; Tsaknis, Georgios; Reddy, Raja

doi:10.7861/clinmed.2021-0512

Cited by 10 publications

(6 citation statements)

References 13 publications

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“…Studies report high satisfaction rates for monitoring in their own home environment [ 12 – 14 , 15 ▪ , 16 ]. One study compared home monitoring combined with and without oxygen (up to 4 l/min) and found comparable readmission rates and mortality, which supports the safety of oxygen at home [ 17 ]. In conclusion, early discharge with home monitoring, oxygen and medication is safe.…”

Section: Hospital Care At Home: Virtual Wardmentioning

confidence: 93%

Home monitoring of coronavirus disease 2019 patients in different phases of disease

Majoor

Vorselaars

2023

Current Opinion in Pulmonary Medicine

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Purpose of reviewVarious home monitoring programs have emerged through the COVID-19 pandemic in different phases of COVID-19 disease. Recent findingsThe prehospital monitoring of COVID-19-positive patients detects early deterioration. Hospital care at home provides early discharge with oxygen to empty hospital beds for other patients. Home monitoring during recovery can be used for rehabilitation and detection of potential relapses. General goals of home monitoring in COVID-19 are early detection of deterioration and prompt escalation of care such as emergency department presentation, medical advice, medication prescription and mental support. Due to the innovations of vaccination and treatment changes, such as dexamethasone and tocilizumab, the challenge for the healthcare system has shifted from large numbers of admitted COVID-19 patients to lower numbers of admitted patients with specific risk profiles (such as immunocompromised). This also changes the field of home monitoring in COVID-19. Efficacy and cost-effectiveness of home monitoring interventions depend on the costs of the intervention (use of devices, apps and medical staff) and the proposed patient group (depending on risk factors and disease severity).

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Section: Hospital Care At Home: Virtual Wardmentioning

confidence: 93%

Home monitoring of coronavirus disease 2019 patients in different phases of disease

Majoor

Vorselaars

2023

Current Opinion in Pulmonary Medicine

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“…Previous studies have focused on the development of virtual wards for specific conditions or groups of patients. For the UK, one of the first countries to trial virtual wards, literature is scarce and the size of virtual wards is smaller compared with the one presented here 3 13 14. In addition, this study is the first example of the assessment of virtual ward cost-effectiveness in the UK within a medium-size hospital facility.…”

Section: Discussionmentioning

confidence: 93%

Length of stay and economic sustainability of virtual ward care in a medium-sized hospital of the UK: a retrospective longitudinal study

Jalilian,

Sedda,

Unsworth

et al. 2024

BMJ Open

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ObjectiveTo evaluate the length of stay difference and its economic implications between hospital patients and virtual ward patients.DesignRetrospective longitudinal study.SettingWrightington, Wigan and Leigh (WWL) Teaching Hospitals, National Health Service (NHS) Foundation Trust, a medium-sized NHS trust in the north-west of England.ParticipantsVirtual ward patients (n=318) were matched 1:1 to 1:4, depending on matching characteristics, to all hospital patients (n=350). All patients were admitted to the hospital during the calendar year 2022.Outcome measuresThe primary outcome is the length of stay as defined from the date of hospital admission to the date of discharge or death (hospital patients) and from the date of hospital admission to the date of admission in a virtual ward (virtual ward patients). The secondary outcome is the cost of a hospital bed day and the equivalent value of virtual ward savings in hospital bed days. Additional measures were 6-month readmission rates and survival rates at the follow-up date of 30 April 2023.Risk factorsAge, sex, comorbidities and the clinical frailty score (CFS) were used to evaluate the importance and effect of these factors on the main and secondary outcomes.MethodsStatistical analyses included logistic and binomial mixed models for the length of stay in the hospital and readmission rate outcomes, as well as a Cox proportional hazard model for the survival of the patients.ResultsThe virtual ward patients had a shorter stay in the hospital before being admitted to the virtual ward (2.89 days, 95% CI 2.1 to 3.9 days). Chronic kidney disease (CKD) and frailty were associated with a longer length of stay in the hospital (58%, 95% CI 22% to 100%) compared with patients without CKD, and 14% (95% CI 8% to 21%) compared with patients with one unit lower CFS. The frailty score was also associated with a higher rate of readmission within 6 months and lower survival. Being admitted to the virtual ward slightly improved survival, although when readmitted, survival deteriorated rapidly. The cost of a 24-hour period in a general hospital bed is £536. The cost of a day hospital saved by a virtual ward was £935.ConclusionThe use of a 40-bed virtual ward was clinically effective in terms of survival for patients not needing readmission and allowed for the freeing of three hospital beds per day. However, the cost for each day freed from hospital stay was three-quarters larger than the one for a single-day hospital bed. This raises concerns about the deployment of large-scale virtual wards without the existence of policies and plans for their cost-effective management.

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“…Supplemental oxygen therapy has been described as part of relatively few remote monitoring pathways, used either to prevent the need for admission to hospital or to facilitate early supported discharge from hospital [ 16 , 30 – 32 ]. Some pathways were designed solely for those requiring home oxygen therapy, whereas others offered home oxygen therapy as part of a wider oximetry monitoring programme.…”

Section: Purpose and Scope Of Home Oxygen Monitoring And Therapy Prog...mentioning

confidence: 99%

“…No deaths occurred in the ambulatory setting, however, the absence of a control group in this study means findings should be interpreted with caution [ 31 ]. A similar study from the United Kingdom of patients with COVID-19 monitored at home with pulse oximetry found no significant difference in the odds of admission or mortality within 30 days of discharge from hospital between those receiving and those not receiving home oxygen [ 32 ]. A study from the Netherlands of 196 patients receiving early supported hospital discharge onto a home oxygen programme for the treatment of COVID-9 was associated with a reduction in length of hospital stay of 6.4 days [ 30 ].…”

Section: Evidence For the Effectiveness Of Oxygen Therapymentioning

confidence: 99%

Home oxygen monitoring and therapy: learning from the pandemic

Beaney¹,

Clarke

2022

Current Opinion in Critical Care

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Purpose of review Home oxygen monitoring and therapy have been increasingly used in the management of patients with chronic diseases. The COVID-19 pandemic has prompted the rapid uptake of remote monitoring programmes to support people with COVID-19 at home. This review discusses the recent evidence and learning in home oxygen monitoring and therapy from the pandemic. Recent findings Many home oxygen monitoring programmes were established around the world during the pandemic, mostly in high-income countries to support early detection of hypoxaemia and/or early hospital discharge. The characteristics of these programmes vary widely in the type of monitoring (self-monitoring or clinician-monitoring) and the patient risk groups targeted. There is a lack of evidence for benefits on clinical outcomes, including mortality, and on reductions in healthcare utilisation or cost-effectiveness, but programmes are viewed positively by patients. Recent studies have highlighted the potential bias in pulse oximetry in people with darker skin. Summary Recent evidence indicates that home oxygen monitoring therapy programmes are feasible in acute disease, but further research is needed to establish whether they improve patient outcomes, are cost-effective and to understand their equity impact.

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Outcomes from a virtual ward delivering oxygen at home for patients recovering from COVID-19: a real world observational study

Cited by 10 publications

References 13 publications

Home monitoring of coronavirus disease 2019 patients in different phases of disease

Home monitoring of coronavirus disease 2019 patients in different phases of disease

Length of stay and economic sustainability of virtual ward care in a medium-sized hospital of the UK: a retrospective longitudinal study

Home oxygen monitoring and therapy: learning from the pandemic

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