Virtual Ward Evaluation

Many existing models of patient care cannot be delivered in rural areas. Such pathways include early supported discharge for patients with exacerbations of chronic obstructive pulmonary disease (COPD). We have previously reduced our inpatient length of stay for patients with an acute exacerbation of COPD (AECOPD) to a median of 5.2 days by using a care bundle and support on discharge without increasing subsequent 30-day readmission rates (5.59%). The recent pandemic increased our use of virtual consultations as well as the innovative use of digital technology to safely discharge patients with Covid-19. We carried out a 12-week feasibility study to see if we could deliver a safe, effective, patient-centred, early supported discharge (ESD) pathway using technology and delivered virtually to patients in the Highlands of Scotland.

Study objectives:

The primary objective of this 12-week feasibility study was to determine whether a safe, effective, and patient-centred ESD pathway could be delivered virtually to patients with AECOPD in remote areas. The study focused on patients admitted to Raigmore Hospital in Inverness and Caithness General Hospital in Wick, assessing the impact of virtual care on inpatient length of stay and overall healthcare costs.

Results

59 patients were admitted with AECOPD. 6 patients were suitable for ESD with 1 patient requiring readmission. Of the remaining 53 patients, 1 patient was a readmission within 30 days and remains in hospital. 13 additional patients have been excluded from this analysis (6 patients died and 7 remain inpatients at the end of the study duration).

The main reason for exclusion was that 67.3% had acute medical issues alongside their AECOPD. Of these, 45% patients had concurrent pneumonia.

The median length of inpatient stay for ESD patients (n=6) was 1.5 days compared to 6 days for those unsuitable for ESD (n=39). There were 286 bed days in total across all 45 patients who completed the 12-week study. ESD saved 22 bed days which is a saving of £12 904.98.

Key Findings

• The median length of stay for ESD patients was 1.5 days compared to 6 days for those unsuitable for ESD.
• Only 1 of the 6 ESD patients required readmission, demonstrating the safety of the virtual discharge process.
• The ESD program saved a total of 22 bed days.
• The savings from the reduced bed days amounted to £12,904.98.
• 67.3% of patients were excluded due to acute medical issues, with 45% having concurrent pneumonia.
• The study supports the feasibility of delivering a virtual, patient-centred ESD pathway for AECOPD patients in remote areas.