‘Essential virtual wards are appropriately planned, resourced and staffed’ – SAM president

Commenting on the development of virtual wards and the need for careful implementation (reported today 07 January by the Health Service Journal), Dr Tim Cooksley, president of the Society for Acute Medicine, said:

“Urgent and emergency care services remain under huge pressure with concerns regarding overcrowding, delays in patient care and exhausted staff with increasing unsustainable workloads exacerbated by the pandemic.

“While some short-term mitigation measures are required in order to manage such periods, it is imperative these are combined with longer-term sustainable innovations to ensure the NHS can deliver high quality acute and emergency care and virtual wards do have the potential to be a model of the future.

“However, it is essential they are appropriately planned, resourced and staffed so they simply cannot be seen as a short-term mitigation measure which can be hastily rolled out mid-pandemic. Incorrect implementation could risk patient safety and significantly impact clinician and patient confidence.

“At present the evidence-base for the new form of virtual wards proposed remains light and, as such, we need to make certain that they are openly and honestly assessed in terms of patient safety, the efficacy of how they work and that they do actually reduce overcrowding and do not simply add a new layer of service.

“Increasing availability and utility of telemedicine (remote) services mean it may certainly be possible to observe and manage patients in their own homes supported with technological innovations that will enable monitoring of a person’s vital signs and blood tests that currently are performed in a hospital setting.

“However, the implementation of this requires careful clinical and operational management and it is vital that those with clinical expertise in the field, such as those working in Acute Medicine and Primary Care, are at the forefront of this work to ensure it delivers its potential impacts. It is also a long-term goal and that is how it must be treated. 

“In the short-term such projects will be resource intense and during the midst of the pandemic that is going to be extremely problematic. Workforce pressures of virtual wards are likely to be significantly underestimated in what is already a depleted NHS workforce and this risks both the success of the implementation and, more importantly, patient safety. 

“It is also important to identify patients that will benefit from being managed on virtual wards and not simply creating work that does not ultimately reduce the pressure on the system.”