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Content ArticleHospital at home and virtual wards provide safe alternatives to hospital care in the community. There is considerable variation in how they are operationalised at a local level. In general, their common feature is to provide healthcare in people’s homes through a multidisciplinary clinical team. Care is delivered both remotely and face to face. They aim to help avoid admission as well as facilitate rapid discharge. The models vary in terms of who leads the service; the hours of operation; the staffing model; the conditions they support; the length of support; how technology is used; and how patients and professionals access the service. In March 2025, NIHR Evidence held a webinar showcasing research on two home-based alternatives to hospital care from three evidence reviews: admission avoidance hospital at home and virtual wards for people with frailty. The webinar addressed: the key elements of hospital at home and virtual wards their impact on outcomes their impact on service costs factors that contribute to their success.
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Content ArticleAll Together Better Sunderland is an alliance of local health and social care services working as an integrated ‘out of hospital’ system. By working in a much more joined up way, it supports Sunderland residents with long-term illness, health problems, mental health issues and disabilities. The service enables them to access care as close to home as possible and live healthy, independent lives. The alliance wanted to find a digital solution which would enable hundreds of elderly and vulnerable people in self-isolation to receive healthcare support with the use of home care technology.
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News Article
Remote monitoring service to be expanded in Norfolk following success
Patient Safety Learning posted a news article in News
Norfolk Community Health and Care it is using a remote monitoring service from Inhealthcare which allows patients to monitor their vital signs at home and relay readings via a choice of communication channels to clinicians who monitor trends and intervene if readings provide any cause for concern. Analysis of the six months before and after introduction showed a significant reduction in hospital bed days, A&E attendances, GP visits and out-of-hours appointments. Lead heart failure nurse at the trust, Rhona Macpherson, spoke to Digital Health News about the impact of the services on patients and nurses. For Macpherson, the service has helped promote self-management. “We give each of the patients a set of scales, blood pressure monitor and pulse oximeter and we get them to do their observations,” she said. “So we’re promoting self-management and looking at things but also it means that we can get accurate information on what’s happening with their observations. “We then set parameters to alert if they go outside of the parameters, and it just means we can intervene much more quickly than we would do, and we can see what’s going on between our visits as well as what’s happening when we’re actually there.” The service has transformed working practices for nurses, increasing efficiency and saving valuable time. Macpherson said: “We’re using the technology to try and make ourselves a little bit more efficient, so it’s saving on the travel time and face to face visits. “We can do a lot more with telephone. We’ve got the option of using video, but telephone is actually quite useful. So it’s less face to face visits, less travel and also, we’re trying to empower the patients to do their own observations and monitor themselves, rather than us just doing it for them.” -
News Article
Royal Surrey County Hospital to launch virtual ward to free up beds
Patient Safety Learning posted a news article in News
The Royal Surrey County Hospital is preparing to open its first virtual ward. From this summer 15 patients will receive treatment at home using apps and wearable technology, as an alternative to a stay in hospital. The ward will be overseen by a consultant, working with therapists, nursing staff and pharmacists. The hospital, in Guildford, plans to extend the ward to 52 patients by April 2024. Health providers across England have been asked to deliver virtual wards at a rate of 40 to 50 beds per 100,000 people by December 2023. It is hoped they will free up beds more quickly, speeding up admissions from A&E and for elective surgery. Read full story Source: BBC News, 7 June 2022 -
Content ArticleHughes et al. studied video consulting in the NHS during 2020–2021 through video interviews, an online survey and online discussions with people who had provided and participated in such consultations. Video consulting had previously been used for selected groups in limited settings in the UK. The pandemic created a seismic shift in the context for remote consulting, in which video transformed from a niche technology typically introduced by individual clinicians committed to innovation and quality improvement to offering what many felt was the only safe way to deliver certain types of healthcare. A new practice emerged: a co-constitution of technology and healthcare made possible by new configurations of equipment, connectivity and physical spaces. Despite heterogeneous service settings and previous experiences of video consulting, we found certain kinds of common changes had made video consulting possible. The authors used practice theory to analyse these changes, interpreting the commonalities found in our data as changes in purpose, material arrangements and a relaxing of rules about security, confidentiality and location of consultations. The practice of video consulting was equivocal. Accounts of, and preferences for, video consulting varied as did the extent to which it was sustained after initial take-up. People made sense of video consulting in different ways, ranging from interpreting video as offering a new modality of healthcare for the future to a sub-optimal, temporary alternative to in-person care. Despite these variations, video consulting became a recognisable social phenomenon, albeit neither universally adopted nor consistently sustained. The nature of this social change offers new perspectives on processes of implementation and spread and scale-up. The findings have important implications for the future of video consulting. The authors emphasise the necessity for viable material arrangements and a continued shared interpretation of the meaning of video consulting for the practice to continue.
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Content ArticleIn this interview for Healthcare IT News, Lisa Hedges, associate principal analyst at Software Advice, discusses the findings of a survey of 1,000 patients on telemedicine usage after the worst of the pandemic. She also talks about the future of telemedicine. The survey found that: more than half of patients are concerned about the quality of care they're receiving through telemedicine. the majority of people prefer virtual appointments for common illnesses. 86% of patients rate their telemedicine experience as positive. 91% are more likely to choose a provider that offers telemedicine. 49% prefer telemedicine visits for mental health treatment, despite it being one of the more remote-ready specialties.
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Content ArticleThis briefing from the Centre of Mental Health summarises evidence from six studies on the use of digital and telephone technology to deliver mental health services. It finds that using remote technology can improve access to mental health support for rural communities, disabled people or people needing a specialist service far from home. It has the potential to increase access and choice in mental health care. But it also risks exacerbating inequalities for people who are digitally excluded.
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Content ArticleHTN Now hosted a panel discussion on virtual wards and the future of remote patient care, with guests Tara Donnelly (director of digital care models at NHS England), Sam Jackson (clinical services manager for the Virtual Health Hub at Hampshire Hospitals NHS Foundation Trust) and Jamie Innes (product director at Inhealthcare).
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News Article
Cleveland-based University Hospitals' spin on virtual nursing
Patient Safety Learning posted a news article in News
Many virtual nursing models involve separate teams where nurses work as either a bedside nurse or a virtual nurse. But Cleveland-based University Hospitals in the USA is taking a different approach. In May, the health system introduced a model in which nurses can work a hybrid schedule, with several days spent at the bedside and the remainder of their schedule at a remote care hub as a virtual nurse. The model is in place across five hospital units, with 23 staff nurses on these units working some of their weekly shifts at the remote hub in an administrative building, health system leaders told Becker's. "We have hardwired all patient rooms in five hospital units with the technology for remote nursing," Michelle Hereford, MSHA, RN, FACHE, chief nurse executive at University Hospitals and the Ethel Morikis Endowed Chair in Nursing Leadership, told Becker's. "Each day, a nurse from each of the five units works in the remote hub in collaboration with their home units and each other." The approach has been a way to deliver on nurses' flexibility demands and allow members of the same team to continue working together. When working a remote shift, nurses are often caring for the same patients with whom they established a connection during a bedside shift at the hospital, making patients more comfortable when a nurse dials in virtually. Read full story Source: Becker's, 30 July 2024 -
EventuntilAiredale’s digital journey: Revolutionising healthcare Starting in 2006, Airedale NHS Foundation Trust digitized patient services, introducing remote health assessments for prisoners. Facing funding challenges for successful pilots, 2010 saw the establishment of the Digital Care Hub with Rachel Binks serving as a key consultant. In 2014, the 24/7 Goldmine service emerged, supporting those in their last year of life with telephonic and video assistance. Goldmine, now a decade strong, is acclaimed for enabling patients to spend their final days at home, supported by grateful families and caregivers. Expanding beyond end-of-life care, MyCare24 was born in 2023 through a joint venture, enhancing service delivery and marketing capabilities nationwide. Airedale NHS Foundation Trust’s digital journey signifies innovation, compassion, and a commitment to reshape healthcare for the future, ensuring tangible, positive impacts on patient care. Register
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News Article
In-person GP appointments save lives and must return
Patient Safety Learning posted a news article in News
Last week a receptionist saved a patient’s life. She put him straight into a face-to-face appointment early in the day. The doctor saw him and sent him to A&E urgently. He was operated on the same day. Receptionists are are given an impossible task, to fit a large number of patients into a small number of slots, and they have to stay calm. When the slots run out – which sometimes happens by 9am – they then have to persuade one of the doctors, already at the end of their tether, to add any patient they are especially worried about to their list. So it’s not surprising that when during the early part of the pandemic demand for appointments dropped by 30%, some very stressed and overworked GPs found their lives were a lot nicer without patients. And now that appointment levels have finally (as of May 2021) gone back to normal levels, some are finding the demand very difficult to cope with. This could explain GPs’ persistence at keeping patients at arms length. Telephone consultations are less intense somehow, less tiring. Some GPs feel they can control the day better by using telephone consultations and only bringing in some patients. But patients are experiencing this persistent distancing as rejection. And these rejections are hurtful. Some people have held on to problems for six months or more and then finally felt free to book an appointment when the restrictions ended in August. Except the restrictions haven’t ended, not in general practice. GPs seem unable to let the remote triage go. GPs say: “We are seeing patients face-to-face. We’ve been seeing them throughout the pandemic,” which is true. But only some patients. Plenty of patients who would have benefitted from a face-to-face appointment or an examination have not been seen. Patients are not idiots. They know telephone consultations are not as good. They know, especially older patients, that proper doctoring involves an examination. They know that the rapport and connection with a doctor can only come from a face-to-face appointments. And they wish to book an appointment with their GP themselves, without facing multiple barriers. Read full story Source: The Independent, 6 November 2021 -
Content ArticleIn this interview for Healthcare IT News, Jennifer Ball, Director of Virtual Care at Saint Luke's Health System in Kansas City talks about the benefits of virtual nursing units, and what training and support is needed to set one up.
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Content ArticleIn this blog, Dr Charlotte Paddison, Senior Fellow at the Nuffield Trust, discusses whether the shift towards digital primary care risks making access easier for people with less need and harder for those more likely to be in poorer health. She also describes the actions that would help make access to primary care easier for different groups of patients.
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Content ArticleWith remote consultations with a doctor becoming more frequent, Trish Greenhalgh explores why this can be difficult and looks at the ways it can be improved. In a recent study, Trish Greenhalgh's team looked at why some remote consultations by video are efficient, effective and well-received but others are logistically cumbersome, technically inadequate and associated with deficiencies in care, such as missed diagnoses or a poor patient experience. While it’s impossible to generalise, remote consultations seem to be less suitable for people who are very young or very old are very unwell with a high-risk condition, such as pneumonia have complex health or wider needs want or need a physical examination have difficulty communicating (though the hard-of-hearing may prefer a video link where neither party wears a mask) need supervised check-ups, for example, for controlled drugs do not own, or wish to use, technologies like smartphones lack privacy at home. Her research has shown that GP consultations should not be remote by default, but that with attention to infrastructure, training and planning, remote consultations could become a realistic option for a much wider range of people than the healthy young professionals towards whom they were originally targeted.
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Content Article
University of Plymouth: Telerehab Toolkit
Patient Safety Learning posted an article in Telemedicine
The Telerehab Toolkit is a patient and practitioner guide to remote appointments for people with movement impairment and disability. Researchers from the Faculty of Health at the University of Plymouth together with collaborators from NHS Trusts in Devon and Cornwall have been working on developing an online toolkit of resources – ‘The Telerehab Toolkit’. The toolkit is designed to support health and social care practitioners in the remote assessment and management of people with movement impairment and physical disability, including people recovering from COVID-19. This project has been funded by the UKRI Medical Research Council. The content of the toolkit is based on interviews and discussions with over 100 practitioners, patients and their family members, a survey of 247 UK practitioners and a review of the latest evidence. It contains sections for practitioners and for patients, with information and guidance on online and telephone appointments as well as links to other useful resources. -
News Article
Concern raised over death of five patients seen remotely by GPs
Patient Safety Learning posted a news article in News
Patients being assessed remotely in general practice, rather than face-to-face, has been raised as a risk in reports on five deaths by a single coroner since the pandemic hit. Senior coroner for Greater Manchester Alison Mutch has written five prevention of future deaths reports highlighting concerns that doctors were missing details in telephone appointments which may have been spotted, had the patient been seen in person. The reports cover a variety of conditions, including covid, a broken femur, and anxiety and depression. In March 2020, NHS England guidance instructed GPs to adopt a “total triage” approach, where face-to-face appointments should generally only follow a phone, video or digital consultation. But, in May, NHSE wrote to GPs to ask them to “ensure they are offering face to face appointments”, adding remote appointments “should be done alongside a clear offer of appointments in person”. There have been growing calls in the media for increased face-to-face appointments, while, in March 2021, a report by Healthwatch concluded: “While telephone appointments are convenient for some, others are worried that their health issues will not be accurately diagnosed.” Maureen Baker, former chair of the Royal College of GPs and Patient Safety Learning trustee told HSJ she was “not aware pre-pandemic of any major concerns with remote consulting”, adding: “It’s not that things don’t go wrong. They do, but things can and do go wrong in face-to-face consultations as well.” “Many practices have been using remote consulting very successfully for many years [but for GPs introducing remote consultations during the pandemic] the concern is that practices will have had to change and implement it very quickly.” Read full story (paywalled) Source: HSJ, 9 September 2021 You may also be interested in a recent blog from Trish Greenhalgh: 'Why remote consultation with a doctor is difficult – and how it can be improved' -
News ArticleMonica Evans's initial misdiagnosis could have proved life-threatening – and she is just one of many to have suffered during pandemic. Since The Telegraph began reporting on the struggles of patients around the country to access GP services during the pandemic, they have been inundated with messages and letters. There have been multiple stories of serious misdiagnoses made after telephone consultations with doctors that took place in lieu of face-to-face assessments; of interminable waits to get through to practices on jammed phone lines; and of lengthy delays while worried patients have waited for referrals to be made. Those who shared their experiences have also shared their fury, frustration, fear and dismay. Some who could afford to have felt they had no option but to turn to private healthcare, unable to obtain the help they needed from an NHS struggling with Covid and all its knock-on effects. Others have been left with nowhere to turn. GPs have spoken, too, about their dissatisfaction with a system that has discouraged face-to-face consultations. Amid an outpouring of anger from both patients and doctors, NHS England yesterday rowed back on plans for "total triage" of patients to keep them out of surgeries whenever possible. But for many the damage has already been done. Read full story (paywalled) Source: The Telegraph, 13 May 2021
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News Article
'I'm traumatised now': Covid bereaved call for inquiry into NHS 111
Patient Safety Learning posted a news article in News
Hundreds of people believe the helpline failed their relatives. Now they are demanding their voices be heard. Families whose relatives died from COVID-19 in the early period of the pandemic are calling for an inquiry into the NHS 111 service, arguing that many critically ill people were given inadequate advice and told to stay at home. The COVID-19 Bereaved Families for Justice group says approximately a fifth of its 1,800 members – more than 350 people – believe the 111 service failed to recognise how seriously ill their relatives were and direct them to appropriate care. “We believe that in some cases it is likely these issues directly contributed to loved ones dying, due to causing a delay in receiving treatment, or a total lack of treatment leading to them passing away at home,” said the group’s co-founder Jo Goodman, whose father, Stuart Goodman, died on 2 April aged 72. Many families have said they had trouble even getting through to the 111 phone line, the designated first step, alongside 111 online, for people concerned they may have COVID-19. The service recorded a huge rise in calls to almost 3m in March, and official NHS figures show that 38.7% were abandoned after callers waited longer than 30 seconds for a response. Some families who did get through have said the call handlers worked through fixed scripts and asked for yes or no answers, which led to their relatives being told they were not in need of medical care. “Despite having very severe symptoms including skin discolouration, fainting, total lack of energy, inability to eat and breathlessness, as well as other family members explaining the level of distress they were in, this was not considered sufficient to be admitted to hospital or have an ambulance sent out,” Goodman said. Some families also say their relatives’ health risk factors, such as having diabetes, were not taken into account, and that not all the 111 questions were appropriate for black, Asian and minority ethnic people, including a question to check for breathlessness that asked if their lips had turned blue. Read full story Source: The Guardian, 21 September 2020 -
News Article
Safety probe launched into NHS 111 Covid triage service
Patient Safety Learning posted a news article in News
Long delays for coronavirus patients to get through to NHS 111 call handlers while other seriously ill patients were told to stay at home have prompted a safety watchdog to launch an investigation of the phone triage service. The Healthcare Safety Investigation Branch (HSIB) has launched an inquiry into the handling of coronavirus calls by NHS 111 – the first port of call for patients when they become unwell. During the pandemic the NHS 111 service set up a dedicated COVID-19 Clinical Assessment Service (CCAS) but concerns over the safety of advice given to patients saw nurses and non-medical staff stopped from taking patient calls in August last year. Now concerns from a number of patients and families have led the independent HSIB to launch a review of the service and to identify any learning and improvements. HSIB told The Independent the investigation was at an early stage and it was not yet certain of any direct link to patient harm. It said the number of patient cases could grow but that it had initial family concerns related to difficulties getting through to NHS 111, long delays in getting clinical call backs after an initial triage call and concerns that some patients were told to stay at home when they were seriously ill. Read full story Source: The Independent, 23 March 2021 -
Content ArticleThe Doctor Will Zoom You Now was a rapid, qualitative research study designed to understand the patient experience of remote and virtual consultations. The project was led in partnership with Traverse, National Voices and Healthwatch England and supported by PPL. The study engaged 49 people over 10 days (June 22nd – July 1st 2020) using an online platform, with 20 additional one to one telephone interviews. Participants were also invited to attend an online workshop on the final day of the study. Using insight from the key findings from the research, this website provides useful tools and tips for getting the most out of your appointment.
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Content ArticleThe Remote by Default research study, a collaboration between the Universities of Oxford and Plymouth and the Nuffield Trust, has been exploring how technology can be harnessed to support excellent primary care. Using workshops, interviews, and focus groups of clinicians, service users, and other stakeholders, they have begun to map the multiple interacting influences on the choice of consultation modality.
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Content ArticleLiverpool is leading the way in the use of smartphone technology to deliver and monitor care in people’s homes. The city is the first to introduce a digital system with almost all domiciliary care providers – giving instant information about 9,000 vulnerable residents to their families and professionals. The use of an app allows care providers and families to see when a visit is carried out by a carer, for how long and how the person responded.The effect is better informed families and care managers and improved care. Liverpool is the only authority in Europe to be using the technology across its city, with all but one of its 18 domiciliary care providers using everyLIFE PASSsystem. It was made possible through a grant of one million Euros of European Union funding secured through the EU STOPandGO programme of which the Innovation Agency, the Academic Health Science Network for the North West Coast was a key partner.
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Content ArticleA digital tablet intervention to record and communicate data on the health of residents was used in care homes in Sunderland. Between April 2017 and March 2018, a small-scale evaluation compared data between eight of the care homes routinely using the intervention with eight similar care homes who weren’t. The evaluation found that the eight care homes using the intervention made an estimated saving of around £756,144 in A&E attendances and ambulance services during this period. The AHSN North East and North Cumbria (AHSN NENC) Well Connected Care Homes Programme commissioned a small-scale evaluation of a new digital health intervention that aims to enhance the appropriateness of healthcare received by care home residents and the skills of care home staff. The goals were to: support care homes in becoming internally and externally ‘well connected’ in the digital age; to enhance the quality of care experienced by care home residents, and by significantly improving communication between care homes and the external health environment. This would provide better and more efficient cost-effective care. It had the following elements: to improve record keeping of care home residents by using tablet-based apps to allow electronic recording of aspects of care plans to train qualified and unqualified care home staff to make and record relevant clinical records (NEWS scores) to promote use of electronic communication of patient clinical information between care homes and primary care (GP electronic patient records), emergency care (including out of hours), and ambulance services and community services.
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Content ArticleVirtual consultations, involving a telephone or video call between surgeon and patient, have been used in several surgical specialties prior to COVID-19. It has, however, played a particularly significant role during the current pandemic which is likely to continue in the post COVID-19 era and in future pandemic planning. This guide provides practical advice for surgeons and managers for delivering virtual consultations with surgical patients.
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Content ArticleThe results of Digital Health Intelligence’s first survey of CNIO Network members provides a ’state of the nation’ insight into nursing and allied health professional leadership in healthcare IT. This webinar offers a chance to learn about some of the key findings of the survey and to hear from senior nursing figures on their thoughts about what it means for where we go next. This webinar will be of interest to: anyone currently working in a nursing/allied health professionals (AHP) clinical informatics role those who aspire to develop their career in this area those who are seeking to set up such a role within their organisation those currently working with CNIOs/AHP informatics leads. Attendees will learn: more about how CNIO/AHP informatics roles are currently set up in the NHS – time commitment, reporting structures etc what the profile is of those holding such roles about possible challenges in connections between CNIOs/AHPs in informatics roles and CCIOs and CIOs thoughts on whether the CNIO/AHP informatics role should be formally recognised further views from senior leaders on the future of these roles.
