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Virtual Ward

🏥 Overview

Virtual Ward monitors patients remotely, providing a safe alternative to hospital admission. Patients are identified as suitable, given monitoring equipment, and undergo a bedside assessment before active remote monitoring.

💡 Benefits

• Avoids hospital attendance, transmission and admission
• Reduces nosocomial transmission and hospital-acquired infections
• Minimises risk of delirium, deconditioning and pressure sores

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📱 How It Works

Step	Process
1. Identification	Patient identified as suitable with estimated monitoring duration
2. Parameters	Prescribed observation perimeters, discharge goals, escalation triggers
3. Assessment	Bedside assessment by Virtual Hub team leader
4. Education	Patient educated on using monitoring equipment
5. Monitoring	Active remote monitoring with step down or escalation as required

Equipment

Special cuff transmits physiological parameters via an electronic tablet. No internet access required.

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✅ General Inclusion Criteria

• Patient has been seen face-to-face by a clinician
• Patient wishes to remain at home
• Patient has a degree of social support
• Patient/patient’s carer has technological fluency

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✅ Referral Reason-Specific Criteria

Acute Frailty

Criterion	Details
Age	65 or older
Frailty Syndromes	One or more of: Falls/Fragility Fractures, Cognitive Impairment, Immobility, Continence, Polypharmacy
Mobility	Can ambulate or complete ADLs appropriate to social care setting

Fractures

Fragility fractures are included if not impacting ability to use monitoring equipment

Chronic Heart Failure

Criterion	Details
Presentation	Volume overload in acute decompensated heart failure
Diagnosis	Pre-existing CHF with reduced or preserved ejection fraction (AHA Stage C or D NYHA)
Treatment	Diuresis initiated

COPD/Respiratory

Criterion	Details
Diagnosis	Confirmed COPD (GOLD stages I-IV)
Treatment	Treatment initiated for exacerbation
Trends	Improving NEWS / Down trending CRP
Additional	COVID +ve or Flu +ve with pre-existing respiratory conditions

Oxygen/Repeat CBG

Provision of O₂ or repeat CBG after 24 hrs if required

Surgical

• Post-surgery monitoring
• Pre-surgery monitoring for low acuity conditions (e.g. gallstones, DVT)

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❌ General Exclusion Criteria

Patients with these criteria should NOT be referred to Virtual Ward:

Criterion	Reason
Acute Delirium	Deemed unsafe for community management
Uncontrolled Pain	Requires inpatient management
Heavy Tattooing	Wrists (affects monitoring equipment)
Bilateral Axillary Fibrillation	Relative contraindication
No Phone Access	No home or mobile phone
Domestic Violence Risk	Safety concerns
Homelessness	Inadequate housing facility

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❌ Condition-Specific Exclusion Criteria

COPD/Respiratory

Exclusion	Details
Respiratory Failure	Acute type 2
Sepsis	Clinical features
New AF	Any new arrhythmia
Organ Dysfunction	2 or more
Multi-organ Failure	Acute

Bronchiectasis

Exclusion	Details
CXR Changes	New changes with features of sepsis

Pneumonia/Pneumonitis

Exclusion	Details
Ongoing Symptoms	Clinical symptoms persisting
Multi-organ Failure	Acute
Sepsis	Clinical features

Chronic Heart Failure

Exclusion	Details
New Onset HF	Or post-myocardial infarction
Hypotension/Hypoxia	Acute
IV Requirements	Vasodilator or inotropic
Device Therapy	Indication for device, mechanical support, or transplant
Vascular Access	Inadequate (if home IV diuretics)
Uncontrolled AF	Or arrhythmia
Goal-Directed Therapy	Would benefit from inpatient stay
Renal Impairment	Severe (eGFR<30) - relative contraindication

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📞 Making a Referral

Contact Number

Call 0300 707 8919 to refer a patient to the Virtual Ward.

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See Also

Resource	Description
Community React Team	Hospital at Home provides bloods and IV therapies
Frailty SDEC	Same-day care for 65+ patients
Medical SDEC	Same-day emergency care