Community Healthcare Cavan, Donegal, Leitrim, Monaghan, Sligo
The CARE community virtual ward (CVW) is an innovative service which provides an alternative care pathway for patients with Chronic Obstructive Pulmonary Disease (COPD) and is the first of its kind in Ireland. A community virtual ward platform pilot scheme that incorporated respiratory rate trends was originally designed, implemented and offered as an alternate to inpatient care to a small group of patients in Donegal. It has now been extended throughout Donegal.
This service gives people living with COPD CVW support, acute care and the treatment they need in their own home which also includes either preventing avoidable admissions into hospital or supporting early discharge out of hospital. Community virtual wards allow patients to get hospital-level care at home safely and in familiar surroundings, helping speed up their recovery while freeing up hospital beds for patients that need them most. Many virtual wards use technology like apps, wearables and other medical devices. In Donegal this is done by the use of novel digital technology to help clinical staff to easily check in and monitor the person’s condition. It will also support patients to become partners in their care by upskilling them in self managing their own condition
The CARE project, funded by Sláintecare, will enable early intervention in the case of exacerbation and will ultimately reduce/negate the need for admission to the acute hospital setting by offering patients with COPD a CARE Virtual Ward.
Patient, carer and family acceptability is high and feedback to the CARE team has been very positive.
Liam (COPD Patient participated in the Community Virtual Ward proof of concept) stated he had ‘lost count’ of the number of admissions he had before going on the Community Virtual Ward and stated: “Honestly it’s hard to put into words what it’s done for me, it’s just changed my life’ he also stated that ‘I found it very comforting that you had your IPAD and that there was somebody, somewhere looking at it.”
A family member of another patient stated: “This has changed my mum’s life. Prior to this, she always had to go to hospital to have her infections treated and for the first time in many years, she has managed to remain at home when ill.”
Now, the 20 bedded CARE Virtual Ward (CVW), with support and governance from the Acute Respiratory Physician LUH, will provide blue tooth enabled equipment, which when worn overnight by the patient, will monitor their respiratory rate which is the most important physiological clinical indicator of deterioration. The patient’s oxygen saturation levels and heart rate will be monitored by the patient as required and information sent to the team via blue tooth enabled equipment.
Monitoring equipment and an App have been designed (in conjunction with HSE National Digital and Innovation team) to the requirements of the local team.
Using a traffic light triage system, this information will alert the clinician to a deterioration in the patient’s condition which will prompt them to initiate a contact with the patient. This targeted, safe virtual care in the community will be followed up by whatever appointment that is deemed necessary e.g. clinic appointment with Physiotherapist/CNS service or a home visit.
The digital technology also offers a variety of patient education materials such as animations, video and individualised care plans which the patient will engage with throughout their admission within the CVW. Individuals will be assessed, optimised and instructed in Self-Management care plans and use of COPD rescue packs. (COPD rescue pack refers to a short course of steroids and antibiotics issued in advance, for a person with COPD to keep at home and use as part of their exacerbation plan.)
In addition to this the RIC service in Donegal aims to use the digital platform as an enabler to progress the COPD outreach service throughout the entire county rather than within the existing limitation of within 33km from LUH. This will allow equity for COPD patients throughout the county regardless of geographical location allowing for increase in supported discharge and hospital avoidance as these patients will be identified in AMAU/ED.
As per HIPE data in LUH Respiratory admissions account for 38 % of overall hospital admissions through the emergency Department. NQAIS COPD data from September 2021 – October 2022 outlines that of these, 28.7% are readmitted within 30 days, this is the highest readmission rate for respiratory patients nationally. The aim of the CARE project is to reduce these readmission rates by 20%. Based on the average Length of Stay (LOS) at 5.8 bed days this equates to a saving of €871,000 for LUH within 1 year of the CVW being fully operational as well as targeting the on-going capacity issues within the LUH Emergency Department.
Mandy Doyle, Head of Primary Care, Community Healthcare Cavan, Donegal, Leitrim, Monaghan, Sligo said:
"The CARE programme demonstrates how Sláintecare works in our communities by making the right care available in the right place. This programme demonstrates how modern pathways of care, alongside technological improvements and innovations can have such a positive impact on patient care.”
Highlighting the impact this project will have, Dr Olga Mikulich, CARE Clinical Lead and Respiratory Consultant at LUH said “We will be ultimately aiming for two-way streams: to facilitate supported discharges of identified patients and to prevent admissions of COPD patients who historically required multiple admissions or ED presentations. In time, we will be accepting referrals from the Hospital COPD outreach team/Respiratory ANP and from GPs too.”
Last updated on: 14 / 12 / 2023
