Implementation and Effectiveness of an Integrated Virtual Frailty Ward in a Rural Setting – the first year.

Introduction: Virtual frailty wards, where patients are treated at home who otherwise would be in an acute hospital, are a model of care being promoted within the NHS in the UK, with the aim to ‘provide an alternative to admission and/or early discharge’. The evidence base for this model of care is limited and the ideal set up has not been defined. The aim is to describe the implementation and delivery of a virtual frailty ward serving a rural community.

Methods: Creating a 7 day a week frailty virtual ward integrated across primary and secondary care. A multidisciplinary team (MDT) focus was adopted utilising existing staffing from partner organisations. Data was collected over a 12 month period. A comprehensive geriatric assessment (CGA) approach was adopted. Daily patient reviews were completed and treatments adjusted with findings. On discharge from the ward patient, carer and staff satisfaction feedback was gathered.

Results: 466 patients managed on the ward, with an average length of stay of 3.7 days. 1724 inpatient bed days saved. Minimum save to the acute trust £862, 000. Average 37% direct hospital avoidance community step-up patients. Average 63% early discharge from hospital step-down patients. 98% positive feedback.

Discussion: Close collaboration across healthcare services and development of trust are key to success of a virtual frailty ward. Impact was clear over a 12 month period with 1724 acute bed days saved. Patient and carer satisfaction was high. MDT attendance remained consistent, with positive feedback from across sectors of the hidden value of the shared learning and education. Actual savings in relation to wider effects are outside of this scope of this study e.g. deconditioning, mortality, but positive outcomes from CGA have been widely published. Further work is required to become more proactive in hospital avoidance and increasing numbers of step up patients.