Alternative CARE Pathway for COPD patients extended in Donegal

Community Healthcare Cavan, Donegal, Leitrim, Monaghan, Sligo

A first of its kind innovative service that gives community virtual ward support to individuals with Chronic Obstructive Pulmonary Disease (COPD) has been extended in Donegal.

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. It will also support patients to become partners in their care by upskilling them in self-managing their own condition.

A community virtual ward platform pilot scheme that incorporated respiratory rate trends was originally designed, implemented and offered as an alternate to inpatient care in Co. Donegal to a small group of patients in Donegal.

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 integrated bespoke platform also incorporates a variety of patient education materials in multimedia formats 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 packs will be prescribed to appropriate patients by the Respiratory ANP or by the patients GP at the request of the respiratory ANP and dispensed by community pharmacists”.    

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 Ogla 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.”