Applying a COVID Virtual Ward model, assessing patient outcomes and staff workload

Area of Science:

• Infectious Diseases
• Health Services Research
• Critical Care Medicine

Background:

• NHS England recommends COVID virtual wards (CVW) for managing COVID-19 patients.
• Outcomes for patients receiving 'usual care' without a CVW are not well-documented.
• Understanding usual care is crucial for evaluating CVW effectiveness and resource allocation.

Purpose of the Study:

• To compare the outcomes of COVID-19 patients managed under 'usual care' versus published CVW data.
• To assess the safety and efficacy of discharging patients who meet CVW criteria without admission to a CVW.
• To evaluate re-presentation rates, hospital admissions, intensive care unit (ITU) escalations, and mortality.

Main Methods:

• Retrospective study of 2301 adult COVID-19 patients at Queen Elizabeth Hospital Birmingham (01/06/2020-31/01/2021).
• Patients assessed against established CVW criteria; follow-up for 28 days.
• Comparison of outcomes for discharged vs. admitted patients meeting CVW criteria against published CVW data.

Main Results:

• 571 patients (25%) met CVW criteria; 325 (57%) were discharged, 246 (43%) admitted.
• Admitted patients meeting CVW criteria: 81% required hospital therapies, 11% died.
• Discharged patients: 13% re-presented, 9% with COVID-19 symptoms; 2% required ITU admission; 0.3% died.

Conclusions:

• Discharging selected COVID-19 patients without a CVW did not result in adverse outcomes compared to published CVW data.
• Usual care appears to be a safe alternative for a significant proportion of patients who would meet CVW criteria.
• Findings support the need for careful evaluation of CVW implementation and resource allocation based on real-world usual care outcomes.