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Abstract
Background Virtual wards (VWs) are being developed to support people at home and avoid hospital admission (NHS England. World-leading NHS virtual wards treat 100,000 patients in a year [News item] 2023 Mar 11). Their development in palliative care is evolving (Black. BMJ Support Palliat Care. 2022;12:A35), however, there is little evidence on optimal processes involved in palliative VW set up.
Aims To describe the process of establishing a palliative care VW and report on its impact.
Methods PDSA methodology used. A task and finish group formed to oversee process. A literature review of evidence on palliative care VWs and a scoping exercise with other hospices with established VWs undertaken. Qualitative feedback undertaken with patients, GPs and hospice staff about their views on palliative care VWs. Evaluation methods for pilot developed including:
Service data collection including demographics, IPOS, Phase of Illness, AKPS, potential inpatient unit (IPU) bed days saved and outcomes.
Cross-sectional survey of patient, hospice staff/GPs’ experience.
Results Qualitative feedback from three patients, three GPs and three hospice staff identified the following themes: need for daily service coordination and senior specialist palliative care clinician oversight, concern over who is responsible for tests/prescriptions and service delivery overnight and at weekends. Patients’ themes focused on coping with technology and what would happen if they deteriorated. A bespoke electronic patient record template was created. Agreement for internal nursing secondment/coordinator was achieved. Admission criteria developed from literature review and scoping exercise included: complex unstable patients with no new daily care needs and on existing hospice caseload. VW admission for up to 14 days. Daily face-to-face/virtual patient contact. Patients discussed at daily huddle. Weekend cover via existing community nursing team. Deteriorating patients considered for IPU admission/other setting. Patients discharged back to usual level of hospice care after 14 days. Results from the evaluation to follow.
Conclusion A palliative care VW pilot using existing resources and reconfiguration has been developed. Evaluation will report on the feasibility and impact of the service.