Presentation on theme: "The Virtual Ward (grasping opportunity!)"— Presentation transcript:
1 The Virtual Ward (grasping opportunity!) RBW 14/5/15
2 Why Virtual Wards?Respond to growing needs of people with chronic health problemsEmergency admissions rising – undesirable for patients and costly in terms of hospital care. (No one explanation for rise in emergency admissions – part patients factors, part health systems – no one solution either)Develop approaches that are preventive before crises emergeLinked structure for managing high risk patients in community settings
3 Purpose of Virtual Wards Avoid preventable hospital admissionsSupport dischargeChronic disease managementEnhanced preparation for scheduled careEnhanced medicine managementEnhanced local access to diagnostics & RxActive Rehabilitation
4 Where to Start? Predictive Modelling: the frailty register Identify a group of patients at increased risk of emergency admissions or needing more complex care.
5 Frailty Register at Builth GPs selecting 5 patients each from their own listsMeeting with DNs to review their existing caseload and select further patientsWe’re aiming for a total of around 30 patients initially (start small, review workload, build confidence)Other strategies: QOF data, MSDI, Inpatient data, A&E data, OOH reports etc
6 Virtual ward team at Builth GPsDN teamNurse specialists (eg respiratory)Physio / OTPharmacistSocial WorkerVoluntary SectorWard clerk(Invited if input required - CPN, Mac Nurse, Tissue Viability etc)
7 Virtual wardA patient is offered "admission" to a virtual ward if general agreement that there is a high risk of a future emergency hospital admission (acute on chronic illness, exacerbations, or complex issues needing more structured, coordinated care).Patients remain in the community and receive multidisciplinary care at the patient's home, by telephone and/or at a local GP practice.
8 Virtual Ward Structure Weekly MDT meeting (Review of frailty register, review of virtual ward patients, agreed admissions and discharges)Daily “office –based” virtual ward rounds to discuss patients on the virtual ward in person or by telephone.The virtual ward staff share a common medical record.Admin supportOOH service flagging
9 Virtual Ward - MDT (Builth) Probably a Monday (potentially all GPs available to attend; often post weekends more decisions required; ensure care plans set up for the week ahead)GP to chair at Builth SurgeryDirect entry into GP record EMISPatients read coded in and out of the Virtual WardVirtual white board – to be developed1 hour duration from 1pm.RV of virtual ward – progress, admissions, discharges,Rolling review of frailty register.
10 Virtual Ward – Daily Round (Builth) Fixed time each morning by losing 2 GP appts.9am to 9.20am.GP and DN present as a minimum.Ideally face to face but, as we run a branch surgery, telephone may be necessary at times.Discussion of virtual ward patients only.Direct entry into GP record (EMIS).Updating of the virtual whiteboard
11 Virtual Ward Responsibility (Builth) Buddy system of 2 doctors to improve continuity:Doctor A – lead Doctor B – Backup Both mandatory attendance at weekly MDTA & B Cover the virtual a ward for one or two weeks at a time (to be decided)
12 Virtual White Board (Builth) Information summary for the virtual ward at any point in time highlighting responsibilities and planned careHeadings:Patients name, admission date, responsible GP, MDT members involved, progress, action points etcMove away from a fixed White Board that doesn’t fit with MDT and Multi site working
13 White Board Patient ID: MDT 2/3/15 Admitted to VW: 25/2/15 History: CCF, PVD, Ulcers on toesOn-going problems: Pain++, amputation recommended, recent bloods OKCare Plan: Continue weekly bloods, pain control, chase op dateCare Coordinator:Outcome: Review 9/3/15Duration of stay:Admission avoided:
14 Read Codes (Builth) Admit virtual ward 8Hv Discharge virtual ward 8HgE On frailty registerEMISNQON5Removed from frailty registerEMISNQRE476Patient declined inclusion on frailty registerEMIS NQPA350Admitted to Glanirfon13F6Discharged Glanirfon8HEZ
15 Problems of Virtual wards Needs clear lines of responsibility & leadershipGPs already working at capacity (slick integration at Practice level required)Increased GP visits?? (Brecon say no)Social Services the rate limiter as usual (limits who can be admitted to the Virtual Ward)Increased use of secondary care??
16 Benefits of the Virtual Ward Currently well fundedEnhanced team working and team satisfactionEnhanced medicine managementActive rehabilitationSupport dischargePositive patient storiesEnhanced patient confidence in home careMoving further away from “GP does all”
17 Future DevelopmentsFurther development and audit of the frailty registerMore in depth anticipatory care of those on the frailty register to prevent virtual ward admissionIncreased use of virtual ward for DGH dischargesGPs taking a more consultative role