The value of a paediatric rheumatology virtual ward round during COVID

ABSTRACT

BackgroundWe aim to provide high value care through optimum patient outcomes with limited resource. As our service has grown rapidly, we identified need for managing complex cases in a different way. To avoid admissions yet allow our team to consider each case in depth and carefully monitor patients remotely over time. We undertook a service redesign project to optimise management of our complex high risk patients through a weekly virtual ward round. This was chaired by the Rheumatology CNS with attendance from Clinical Fellows and Consultants. Consequently, we were able to avoid loss to follow up and potential undesirable events including admissions to local hospitals, loss of schooling or parental work absence. Here we describe the process and value of the virtual ward round.ObjectivesActive monitoring of high risk, high need complex patientsReduce admission ratesRemotely manage/avoid unnecessary appointmentsReduce unnecessary GP contactsMethodsRetrospective reviews of the weekly minutes with both qualitative and quantitative data collected. The CNS team generated a list of patients with clinical or social concerns, complex disease, frequent contact, upcoming transition, regular infusions and inpatients. Patients were divided into three categories;red, amber and green to highlight the concern level. Patients moved between groups as required and were taken off the list once concerns were dealt with.ResultsAn average of 58 patients were listed each week from a database of 791 and 16 decisions made on average. Discussions focussed on areas of concern therefore not all patients were discussed at each meeting. These decisions included new requests for day unit treatment/assessment, medication changes, changing appointments, referral to other specialties and whether patients can be removed from the list. There were no unexpected outpatients admitted. Patient conditions included Juvenile Idiopathic Arthritis, Systemic Lupus Erythematosus, Juvenile Dermatomyositis, Vasculitis, Scleroderma and Mixed Connective Tissue Disease with decisions leading to involvement from our colleagues in the dermatology and renal departments for many. A significant proportion of patients were added to the list due to social concerns or poor engagement.ConclusionsThis project identified the high level of productivity possible by continuing a weekly virtual ward round during a very difficult year. It is a reliable and resilient method for the team to keep track of a complex patient cohort. Data collection also highlighted the valuable learning for individuals and the team as a whole by sharing knowledge, discussing treatment plans and problem solving difficult cases. Limitations to this project include limited prospective data collection for contemporaneous analysis and the use of very basic computer systems to record outcomes. Going forward we plan to develop this meeting with the potential to upscale and use similar formats for other patient groups. It would also be important to assess technology options available to assist more detailed documentation and analysis of the outcomes. Through this low cost implementation there has been highly valuable output with overall improvement of patient care quality and consistency.