19th May 2020

In response to the COVID-19 pandemic, the Outpatient Parenteral Antimicrobial Therapy (OPAT) team at Wythenshawe Hospital, in Manchester, UK, utilised its skills in assessing patients remotely to develop a COVID-19 Virtual Ward. Lead Nurse, Liz Wilson, explains the process and considers how these experiences could instruct best practice in the future...

“Our COVID Virtual Ward (VW) was created mid-March in anticipation of the large volumes of COVID patients expected at our Trust. The aim of the service is to facilitate an early supported discharge from the acute setting for patients with confirmed or suspected COVID-19.  Support is provided, in the first instance, by regular telephone assessments conducted by the OPAT nurses, with facility to escalate ‘patients of concern’ to local community teams who will then visit patients face-to-face, or, where necessary, bring patients back into the acute setting.

We have developed a red/amber/green triage system that reflects a ‘level of concern’ that is attributed to each patient during each telephone consultation; red is high, amber is medium and green is low. Red patients receive a daily call (at least), amber every 2 days and green every 4 days until discharge from the VW.

At every telephone call the patient’s breathlessness is used as a measure of their clinical condition. The difficulty faced by the VW clinicians is that whilst breathlessness is a very concerning symptom there is currently no validated tool for assessing it remotely. Therefore, the key question asked of every patient is ‘how is your breathing today?’ with further clarification of improvement/deterioration, based upon the NHS 111 symptom checker for breathlessness and advocated as a means of remote assessment in primary care.

Some VW patients are discharged from the acute setting with a fingertip pulse oximeter which allows the clinician to also check SpO2 and heart rate during the telephone consultation. Pulse oximeters are reserved for our more vulnerable patients identified as a higher risk of deterioration for example the elderly patient who lives alone, COPD patients or those who have been particularly dependent upon oxygen therapy whilst in the acute setting.

As this pandemic continues, we are reminded of the vital importance of treating people out of hospital wherever appropriate, not only to limit the spread of COVID-19, but to reduce transmission rates of all infectious diseases, including Antimicrobial Resistant (AMR) pathogens. We hear much talk of the ‘new normal’ – perhaps OPAT services, tele-consultations and virtual wards will play an integral role in keeping us healthy long after this pandemic is over.”

Liz Wilson, Lead Nurse, OPAT Team, Wythenshawe Hospital

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