Technology-enabled virtual ward for COVID management of the elderly and immunocompromised in Singapore: a descriptive cohort

Abstract

Background To address the hospital bed demand for Delta and Omicron surges in Singapore, the National University Health System (NUHS) developed a COVID Virtual Ward to relieve bed pressures on its three acute hospitals—National University Hospital, Ng Teng Fong General Hospital, Alexandra Hospital. To serve a multilingual population, the COVID Virtual Ward featuring protocolized teleconsultation of high-risk patients, use of a vital signs chatbot, supplemented by home visits where necessary. This study aims to evaluate the safety, outcomes and utilisation of the Virtual Ward as a scalable response to COVID-19 surges. Methods This is a retrospective cohort study of all patients admitted to the COVID Virtual Ward between 23 September to 9 November 2021. Patients were defined as “early discharge” if they were referred from inpatient COVID-19 wards and “admission avoidance” if they were referred directly from primary care or emergency services. Patient demographics, utilisation measures and clinical outcomes were extracted from the electronic health record system. The primary outcomes were escalation to hospital and mortality. Use of the vital signs chatbot was evaluated by examining compliance levels, need for automated reminders and alerts triggered. Patient experience was evaluated using data extracted from a quality improvement feedback form. Results 238 patients were admitted to the COVID Virtual Ward from 23 September to 9 November, of whom 42% were male, 67.6% of Chinese ethnicity. 43.7% were over the age of 70, 20.5% were immunocompromised, and 36.6% were not fully vaccinated. 17.2% of patients were escalated to hospital and 2.1% of patients died. Patients who were escalated to hospital were more likely to be immunocompromised or to have a higher ISARIC 4C-Mortality Score. There were no missed deteriorations. All patients received teleconsults (median of 5 teleconsults per patient, IQR 3–7). 21.4% of patients received home visits. 77.7% of patients engaged with the vital signs chatbot, with a compliance rate of 84%. All patients would recommend the programme to others in their situation. Conclusions Virtual Wards are a scalable, safe and patient-centered strategy to care for high risk COVID-19 patients at home. Trial Registration NA.

Evaluation of a virtual ward model of care and readmission characteristics during the COVID‐19 pandemic within an Australian tertiary hospital

“…[4][5][6] Reassuringly, VWs have maintained relatively robust safety profiles and patient satisfaction, whilst avoiding common complications associated with hospital admissions. [7][8][9] Despite these benefits, equitable access remains a challenge for patient care, with striking disparity in terms of technological access and connectivity, digital literacy, language barriers and socioeconomic status. 10,11 In addition, risk categorisation and escalation pathways remain divergent across health services, in part due to the rapidly changing nature of the pandemic and the associated evolution of variants, vaccinations and treatments.…”

“…Such systems have been further supported by the implementation of remote monitoring mechanisms that allow earlier identification of well‐described phenomena such as ‘silent hypoxaemia’ 4–6 . Reassuringly, VWs have maintained relatively robust safety profiles and patient satisfaction, whilst avoiding common complications associated with hospital admissions 7–9 …”