Background With a second wave of COVID-19 peaking in mid-December 2020, one hospice closed its inpatient unit to allow clinical staff to be utilised to greater effect in the community. This approach had been used during the first wave of the pandemic, with good effect, allowing more referrals and more patients to be cared for in their place of choice. However, for a very small number of complex patients, the lack of inpatient facilities had proved problematic. To avoid this consequence during the second wave, a new plan to open a virtual ward, staffed by some of the inpatient team, was devised.

Aim To ensure that dying patients with complex needs were given equitable and appropriate care whilst the inpatient unit was closed.

Method Clinical staff were once more re-located to the community teams, but this time with 24-hour provision of nursing care, rather than the usual four times daily visits. Medications were administered in a more timely way, and delivery of personal care was given at the patient’s convenience, rather than set times, with increased support for families. Closer liaison with the multi-disciplinary team (MDT) also improved the patient experience, with daily MDT discussion.

Results Eight patients who required complex medical intervention, were admitted to other local hospices. However, 47 patients were admitted to the virtual ward, averaging 8.6 admissions per month. Identification of the last weeks of life was greatly improved by the internal referral process, reflected in an average length of stay of 7 days (range 3-13 days).

Conclusion By offering complex care to people at end of life in their own homes, this approach fulfilled the ideal criteria of ‘providing everyone the right care, from the right person at the right time’ and reduced prior inequality of care provision (Thomas, 2021).