Abstract

The Diagnostic Virtual Ward is a cross-specialty initiative which aims to support the earlier discharge of a low-risk cohort of inpatients within Bradford Teaching Hospitals NHS Foundation Trust.It is designed for inpatients who are clinically stable but who require at least one investigation in an urgent timescale.The service offers an opportunity to shift their care from hospital to home.

We held discussions with key stakeholders whilst designing this service.These included staff from medical and surgical specialties, radiology, endoscopy, and cardiac investigations.A coordinator was recruited.The service was initially offered as a pilot on one ward in September 2016 and subsequently spread to other areas.Ward staff contact the coordinator to make a new referral.She visits the ward, checks patient suitability and explains the service to the patient prior to discharge.The coordinator then liaises with the relevant investigation department(s) and contacts the patient.She tracks the patient’s progress and, upon completion of their investigation(s), forwards the result(s) to their consultant.

During its first year, 963 patients were referred to the Bradford Diagnostic Virtual Ward for 1103 planned tests.541 patients were female.The service was used by 19 specialties with the largest usage seen in general surgery, urology and stroke medicine.83% of patients progressed through the pathway as intended.4.9% of patients were readmitted whilst on the pathway.1.7% of patients had problems such as claustrophobia at their test requiring rescheduling.10.5% of patients did not attend their test as initially planned.52% of test results were abnormal but only 2.3% required same-day action. There were no reported adverse events.

This initiative has saved the trust an estimated 1960 bed days in its first year, representing a minimum potential net saving of £3 48 000.Our main challenges are improving staff awareness of the service, ensuring a robust governance structure and fully integrating this service with the recently implemented electronic patient record.