The af virtual ward, right care, right time and right team

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Atrial Fibrillation (AF) is the most common cardiac arrhythmia. AF related hospital admissions are rising, with significant cost and capacity implications. Virtual wards are novel pathways designed to support patients remotely, whilst maintaining safe high quality patient care, changing the landscape of care provision. Purpose The standard pathway for patients presenting acutely with AF or Atrial flutter (AFL), is to remain in hospital between 2-5 days, attached to a heart monitor until achieving rate or rhythm control. We developed an AF Virtual ward run by a specialist multi-disciplinary team; to provide remote out-of-hospital care for patients with AF or AFL and rapid ventricular response whilst focusing on improving patients’ care pathway and experience. Methods Patients presenting acutely with AF or AFL who met the criteria for our virtual ward, were on-boarded from an acute hospital admission area or outpatient department. Patients were given access to electronic platform (Dignio) via their smartphone or tablet. They were provided with instruction on how to use a blood pressure machine, single lead ECG device (Kardia) and a pulse oximeter. Once discharged they submitted readings, at least twice a day. Patients who didn’t have access to smart phones were provided with electronic tablets to ensure digital inclusion. Patients’readings, current medication and co-morbidities were assessed by Advanced Clinical Practitioners, Cardiology Registrars and Consultants on "virtual ward rounds". They were supported via messaging through the platform, telephone or video consultations. Health education, lifestyle advice, medication adjustments, and clinical decisions were undertaken remotely by the clinical team. Results A retrospective analysis of the first 50 virtual ward admissions from January - August 2022 was undertaken. Initial hospital admissions were completely avoided in 24 patients due to on-boarding from the outpatient department. Medical interventions by the specialist team prevented 25 readmissions, saving a total of 49 hospitalisations and between 98 - 245 bed days. A rhythm control strategy was pursued in 82% and sinus rhythm was achieved in 36% on discharge. A total of 28% patients were referred for direct current cardioversion (DCCV) and 30% for catheter ablation. The prompt development of a treatment plan avoided attendance in a specialist Cardiology outpatient clinic whose waiting time for an appointment is approximately 6 months. The NHS friends & family test was completed by 90% of the patients with 100% positive responses. Feedback themes revolved around empowerment, feeling safe, actively participating in their care, and avoiding hospital stay. Conclusion The innovative changes to create the AF Virtual ward has facilitated bed efficiencies allowing "hospital-at-home" remote care through prompt care by a specialist multidisciplinary team, with 100% patient satisfaction.