Virtual ward feasible home-based care strategy for high-risk COVID-19 patients

A technology-enabled virtual ward may be a feasible alternative to hospitalization for high-risk COVID-19 patients such as the elderly and the immunocompromised, a retrospective cohort study from Singapore suggests.

With the emergence of the Delta variant and an upsurge in daily COVID-19 cases in Singapore, admitting all COVID-19 patients to hospitals put a strain on healthcare resources. [www.channelnewsasia.com/singapore/icu-bed-occupancy-rises-53-amid-exponential-rise-covid-19-cases-2219831, accessed July 10, 2023] To address the demand for the surge in cases, the NUHS* developed a COVID Virtual Ward to relieve bed pressures on its three** acute hospitals.

“[This ward featured] protocolized teleconsultation of high-risk patients, use of a vital signs chatbot, supplemented by home visits where necessary,” said the researchers. “[We aimed] to evaluate the safety, outcomes, and utilization of the virtual ward as a scalable response to COVID-19 surges.”

From 23 September to 9 November 2021, 238 patients were admitted to the COVID virtual ward (mean age 62.5 years, 58 percent female, 68 percent Chinese). A little over 40 percent were ≥70 years, 20 percent were immunocompromised, and 37 percent were not fully vaccinated. The primary outcomes were escalation to hospital and death. [BMC Infect Dis 2023;23:102]

The goal of the virtual ward is to provide comprehensive home care to substitute hospital stay and eventually avoid hospital admissions or allow earlier discharge. In the study, only 41 patients were escalated to hospital from ward, and there were only five deaths (all due to COVID-19 pneumonia).

“Patients who were escalated to hospital were more likely to be immunocompromised or to have a higher ISARIC*** 4C-Mortality Score. There were no missed deteriorations,” said the researchers. More than half of those who were escalated recovered and were discharged well, while a third returned to the virtual ward upon stabilization of their condition.

All participants received teleconsults (median five per patient). About a quarter (21 percent) received home visits. Despite concerns regarding the ability of participants to handle teleconsultations (especially the elderly), more than three-quarters of patients engaged with the vital signs chatbot, with a compliance rate of 84 percent.

“The use of remote monitoring and teleconsultation enables prompt escalation of at-risk cases for early treatment, early identification of deterioration to avoid intubation, and management of chronic diseases during the isolation period,” the researchers explained.

Moreover, patient feedback was positive overall. All patients noted that they would recommend the programme to others in their situation.

“[Taken together, our study showed that] among high-risk COVID-19 patients who are clinically stable, admission to a virtual ward is a safe, patient-centred, and scalable alternative to inpatient hospitalization,” the researchers concluded.

“Healthcare financing policies should develop supporting payment strategies to enable sustainability of virtual wards which can quickly pivot to COVID-19 care as future pandemic waves and variants of concern emerge,” they added.

The researchers also called for more studies to assess patient experiences in a virtual ward setting as well as the effect of home-based isolation and treatment on exposure and infectivity of household contacts, and to compare this approach with hospital/institutional treatment and self-management at home.