Dr Camille Aznar
Camille has ten years’ experience of working in health policy research. Her current role at the Health Innovation Network (the Academic Health Science Network for South London), and former roles at Ipsos MORI and NatCen have involved managing and delivering health policy evaluation and research projects. Since working at the HIN, she has managed and carried out a number of real world evaluations of complex interventions within complex systems. Examples of work she has delivered include evaluations of virtual wards, remote monitoring services, and innovative health programmes in London. Camille has also an interest in developing methodological strategies that facilitate research participation for vulnerable and disadvantaged groups. For instance, her doctoral research involved in-depth research with Congolese and Cameroonian francophone participants.
Virtual wards (VWs) support patients to receive the acute care, monitoring and treatment in their own home, which would otherwise be provided in hospital. The rapid implementation of VWs was a direct response to the pandemic; however, there is an ambition in England for the expansion of the model i.e. 40–50 ‘virtual ward beds’ per 100,000 population by December 2023(1). There still is limited evidence about all aspects of VWs(1,2). This evaluation explores the early implementation of VWs in 2021-22.
1. Enablers for success: virtual wards including hospital at home [Internet]. NHS England; 2022. Available from: https://www.england.nhs.uk/wp-content/uploads/2022/04/B1382_supporting-information-for-integrated-care-system-leads_enablers-for-success_virtual-wards-including-hos.pdf
2. Best J. The virtual wards aiming to ease hospital pressures. BMJ. 2022 Jul 6;378:o1603.
A mixed-methods case study approach was used of three NHS VWs across South-West London (SWL) using in-depth interviews with clinical staff in/working directly with VWs (n=14), patients admitted and treated on VW (n=14), documentation, and routinely collected demographic, activity and outcome data.
VWs were used for a range of conditions beyond COVID-19 (e.g. exacerbation of a long-term condition). Patients tended to >65 years old, white and female. Although discharge outcomes varied between the VW models, patients across the three services were able to be cared for at home. Patients felt they were being kept out of hospital whilst receiving the same standard of care as they would in a hospital environment. Clinical VW staff highlighted positive experiences of working on the ward.
Factors influencing the successful implementation of VW models were:
• Offering continuous monitoring to all patients
• Referring a small but targeted cohort of patients
• Developing established clinical and referral pathways
• In-reach virtual ward staff based in acute settings
• Strengthening relationships with acute trust and VW staff
• Building multi-disciplinary teams
• Clear clinical governance arrangements in place
Early evidence in SWL shows VWs have been successfully implemented and expanded to care pathways beyond patients with COVID-19 with patients being treated safely and comfortably at home. Common factors enabling implementation were identified across three different VWs models.