SETTING UP A 'VIRTUAL WARD' WHEN THE INPATIENT UNIT CLOSES: LEARNING FROM CRISIS AND OPPORTUNITY

Background Farleigh Hospice provides palliative and end-oflife care to the people of Mid Essex (population c. 400,000), with a dedicated inpatient unit (IPU) and community services. Problem The first wave of the COVID-19 pandemic catalysed organisational change with creation of 'Locality Care Teams' and the upskilling of non-clinical members of staff. Subsequently, the IPU closed and staff were reassigned to Locality Care Teams in November 2021, mobilising the workforce to care for more patients. However, there was a resulting potential for some patient and carer needs to go unmet. Intervention A community-based nurse-led 'Virtual Ward' was created in mid-December at rapid pace, to support people to die at home. A detailed SOP was developed, specifying the purpose of the Virtual Ward, eligibility criteria, and referral, assessment and discharge processes. This information was disseminated to all teams. Data were collected throughout the time of IPU closure. Outcome Within a short time, the virtual ward was well-utilised (mean 8.6 admissions per month). Referrals to the Virtual Ward were largely appropriate with mean length of stay seven days, median three days. 80% of patients admitted to the Virtual Ward died as expected while under its care;none were admitted to acute care services. Informal feedback has been positive from referrers, patients and family caregivers. Learning The temporary closure of the IPU could have caused patient and carer needs to go unmet. Instead, the rapid set up of the Virtual Ward, alongside the reassignment of IPU staff and arrangements with other regional hospices, has enabled the local population's end-of-life care needs to be well met. During the pandemic the greatest need for palliative care services has been in the community (Etkind, Bone, Lovell, et al., 2020;Costantini, Sleeman, Peruselli, 2020). Farleigh Hospice's reconfiguration of services has proven to be effective and responsive. There is a need for more robust data collection to evaluate outcomes particularly with regard to patient and family caregiver feedback.

Considerations and strategies in the organisation of obstetric anaesthesia care during the 2019 COVID-19 outbreak in Singapore.

The provision of safe obstetric anaesthesia services is essential during the COVID-19 global outbreak. The identification of the 'high-infection risk' parturient can be challenging especially with the rapidly changing risk criteria for COVID-19 'cases'. A multidisciplinary taskforce is required to review the infection control protocols and workflows for managing the parturient for labour analgesia and for caesarean section in order to minimize infection risk to healthcare staff and other parturients. A constant review of such processes is needed to enhance efficiency and to optimise use of finite resources. Good communication between health officials, institutional leadership and ground staff is essential for the dissemination of information.