JMIR Publications

ABSTRACT

Background:

The Covid-19 pandemic placed substantial stress on global healthcare systems’ acute capacity and diverted significant resources away from elective care to prioritise the care of people with acute respiratory disease. The national health service (NHS) response in Leicester, Leicestershire, and Rutland (LLR) in preparing for a second wave of Covid-19 infections was to try to protect capacity in the winter of 2020/2021 and included the introduction of a virtual ward where patients were discharged home early supported by specialist respiratory nurses and physiotherapists and a digital patient monitoring system that commenced enrolling patients in November 2020.

Objective:

The objective of this study was to demonstrate the impact of a virtual Covid-19 respiratory ward on NHS resource use in 310 patients discharged into that setting.

Methods:

Different methods were used to help overcome the uncertainty associated with estimated comparators for the observational data on acute length of stay (LOS) versus the actual lengths of stay of the 279 patients who had not required oxygen during their hospitalisation. Historic comparative lengths of stay and an ordinary least squares model based on local monthly median lengths of stay were used as comparators. Comparator data had been sourced for the 31 patients who were discharged home for oxygen weaning. Resource use associated with delivering care in the virtual ward was collected on an ongoing basis by the patient remote monitoring system.

Results:

The objective of the virtual ward was to maintain acute capacity through early discharge of patients with Covid-19 respiratory disease. Costs had been a secondary concern. In the base case, the virtual ward delivered estimated health care system savings of 831 bed days, £387,787 in net financial savings across two key groups of patients (both P<.001); those who required oxygen weaning while within the virtual ward and those not requiring oxygen therapy with less severe acute Covid disease. The mean gross and (net) savings per patient were £1,426 (£1,251) in the base case without including any savings associated with a potential reduction in re-admissions. The 30-day re-admission rate was 2.9%, and substantially beneath comparative data. The mean cost of the intervention was £175.09 per patient, 12.3% of the estimated gross savings. It was not until the costs were increased and effect reduced simultaneously by 81.8% in the sensitivity analysis that the intervention was no longer cost saving.

Conclusions:

The virtual ward delivered significant financial savings in both groups of patients, did so with a high degree of confidence, whilst doing so at a very low absolute and relative cost. Clinical Trial: The study was evaluated by the Institutional Ethics Review body of DeMontfort University and approval was waived for the protocol as it was an economic analysis of a service evaluation.