COVID oximetry@home implementation: Phase 1 preparing the system

Stakeholder engagement and mobilisation

Key tasks

Join the FutureNHS collaboration platform and FutureNHS group
Identify key internal and external stakeholders
Identify key clinical lead(s) and project lead(s) for operational delivery
Understand and link with NHS Volunteer Service (GoodSAM) – please check volunteer capacity in the individual area
Liaise with NHSX to align with remote monitoring, virtual consultations and use of digital technology in care homes
Connect into local Patient Safety Collaborative network

Further information

A national decision has been made to restrict access to this toolkit to those with an NHS.net email address. You can sign up to access the toolkit here and by requesting access to the National Patient Safety Deterioration Forum. Once access is granted, click on the link in the forum for the COVID 19 Virtual Ward Toolkit.

Key learning from pilots: Role of influential, dedicated clinical leaders in establishing. Significant support and ‘buy in’ from senior management within acute trusts and across CCGs to set up virtual wards. Some acute hospitals had pathways in place (i.e. ambulatory care) which supported the set-up of virtual wards more quickly.

Appreciating different groups may be required for acute step down and community based primary care step up, collaborating and cross working between these groups remains essential to allow system alignment, along with involvement from urgent care services including 111, out-of-hours and the South West Ambulance Service. Here is an example stakeholder list

Rapid diagnostic of existing services and population needs

Key tasks

Complete system-level diagnostic to include assessment of current models, capability, capacity to change, existing forums, and local system baseline
Agree outline scope of programme to enable consensus on model of clinical pathway and plan for implementation
Map out QI training needs

Further information

Considerations for the virtual ward that can affect scope include: Primary or acute / secondary care based; pre-hospital only, and / or step-down (and whether this includes chronic / long COVID care); patient demographics including age; risk stratification levels used to determine active/ passive monitoring; threshold for admission (symptomatic / clinical suspicion / COVID positive test); utilisation of existing infrastructure, particularly around patient record systems; operational hours (in hours/ out of hours / 24-7); footprint (GP practice/ primary care network/ acute care footprint / countywide).

The AHSNs will act as an enabling and co-ordinating support function within the region. Example QI resources from PreciSSIon.

Establishing local implementation structures and governance

Key tasks

Agree governance oversight group
Agree operational delivery group membership and meeting frequency
Map out interdependencies with other local, regional and national workstreams
Establish risks and issues log

Potential risks identified from pilot areas as a starter for implementing teams to consider:

Wave 2 pandemic hits prior to COVID oximetry@home being established; pace of coordinated work required to achieve implementation timescales; not targeting support to areas / teams in greatest need; not agreeing target populations to be covered by COVID oximetry@home/ identifying wrong target population (inclusion/ exclusion criteria); resourcing for local implementation not agreed; funding within systems to support the establishment of the model not agreed – needs to address workforce requirements robustly/ opportunity cost of limited workforce/ staffing challenges; stakeholders are unable to easily access information/ are not reached by communication messages; risk of competing priorities within operational pressures.

Evaluation

Key tasks

Agree key metrics and benefits
How are you planning to collect and share your data?
How will you gain patient and public feedback?
Do you have a member of the team responsible for collecting local data, summarising staff and patients’ comments, reviewing and acting on the findings?
Identify possible case studies for shared learning
Understand national expectations for data reporting
Agree metrics and reporting system to demonstrate impact of new models and evaluate ROI and outcomes

Further information

The HSJ have produced a suite of short training/information videos. These explain the background information for COVID oximetry@home models based on first wave pilots highlighting Oxygen levels as a key indicator for deterioration in COVID-19, and why patients need to be monitored for silent hypoxia. The videos describe to GPs, Nurses, Paramedics, Care home staff how this can be done across the system to safeguard patients at home in COVID oximetry@home virtual wards. Watch the HSJ videos here.