The Role of Virtual Wards in Reducing Unplanned Admissions

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The Role of Virtual Wards in Reducing Unplanned
Admissions

• Maggie Ioannou MSc BA RGN RSCN RHV
• Director of Community Health Services
• Croydon PCT

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Identifying Patients

• Key to success is in accurate identification of
  patients
• Clinician referrals do not work
• Threshold modelling (e.g. all patients aged gt65
  with 2 admissions) do not work

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Regression to the mean
50
45
40
35
30
Average number of emergency bed days
25
20
15
10
5
0
Intense year
- 5
- 4
- 3
- 2
- 1
1
2
3
4
4
Emerging Risk
50
45
40
35
30
25
Average number of emergency bed days
20
15
10
5
0
- 1
1
2
3
4
- 5
- 4
- 3
- 2
Intense year
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Predictive Risk Modelling

• Kaiser Permanente and other US providers have
  been using this method successfully for 20 years
• Their algorithms are proprietorial
• NHS commissioned its own algorithms which can be
  downloaded free of charge by PCTs

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AE data
GP Practice data
In-patient data
Social Services data
Out-patient data
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Intervention
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10 Croydon Virtual Wards

• Croydon population
• 340,000
• 10 virtual wards
• Catchment population of 34,000 residents per ward
• One ward per 15 GPs
• 100 beds per ward

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• Virtual Wards
• Mimic hospital ward
• Patients cared for in their own homes
• No physical ward building, hence the term virtual
  wards
• Patients case managed by multidisciplinary team
• Ward Team headed by Community Matron

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Virtual Ward A
Virtual Ward B

• Specialist Staff 
• Specialist nurses
• Asthma
• Continence
• Heart Failure
• etc.
• Palliative care team
• Alcohol service
• Dietician

Virtual Ward A Community Matron Nursing
complement Health Visitor Ward Clerk Pharmacist So
cial Worker Physiotherapist Occupational
Therapist Mental Health Link Voluntary Sector
Helper    
Virtual Ward B Community Matron Nursing
complement Health Visitor Ward Clerk Pharmacist So
cial Worker Physiotherapist Occupational
Therapist Mental Health Link Voluntary Sector
Helper
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Medical Input

• Community matron given the bypass telephone
  number to the duty doctor at each of the
  constituent GP practices
• Community matron able to book appointments to see
  the patients usual doctor

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100 patients per ward
Weekly 35 Patients
Monthly 60 Patients
Daily 5 Patients
5
(35 ? 5)
(60 ? 20)
5 7 3 15 patients for discussion each day
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Key Strengths

• Patients identified according to predicted need
  thereby reduces health inequalities and counters
  the inverse-care law
• Multidisciplinary, multi-sector partnership
• Eliminates duplication
• Patient-focused
• Simple intervention that is being adopted across
  the UK

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Lessons learnt so far 1

• Wards must make sense to primary care teams
• Takes time to integrate social care
• Issues of confidentiality must be faced early
• Impact across whole system is dynamic in
  particular community nursing
• Takes time to keep acute trust on board and not
  antagonistic

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More lessons

• Do not underestimate change management demands
• Trying to map savings across HRG groups is very
  complicated
• Important to remember that savings are whole
  system not attributable to one intervention
• Public relations crucial
• The price of winning awards!

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What makes the partnership work

• Genuine trust and respect
• Shared vision that unplanned admissions are
  frequently avoidable
• Communication at all levels
• Sharing success creating solutions together
• Facing the difficult issues in an open manner
  brush nothing under the carpet
• Leadership
• Can do environment