ABSTRACT
BACKGROUND: Chronic respiratory diseases are responsible for significant patient morbidity, mortality, and healthcare use. Community virtual ward (CVW) models of care have been successfully implemented to manage patients with complex medical conditions. AIMS: To explore the feasibility and clinical outcomes of a CVW model of care in patients with chronic respiratory disease. METHODS: Patients known to specialist respiratory services with Chronic Obstructive Pulmonary Disease (COPD) and/or asthma were admitted to the CVW for disease optimisation and exacerbation management. Individualised management plans were delivered in the patients' home by hospital-based respiratory and community nursing teams, incorporating remote technology to monitor vital signs. Symptoms and health status at admission and discharge were compared. RESULTS: Twenty patients were admitted. One-quarter of patients had asthma, 50% COPD, and 25% combined asthma/COPD. Patients had severe disease, mean (SD) FEV1 50(20) % predicted, and an average 6.4(5.7) exacerbations of disease in the previous 12 months. Patients received personalised disease and self-management education. All acute exacerbations (n = 11) were successfully treated in the community. The average length of CVW admission was 10(4) days. By discharge, 60% of COPD and 66% of asthma patients recorded improvements in symptoms score exceeding the minimal clinically important difference. Fifty percent had clinically meaningful improvements in health status. CONCLUSION: A CVW model facilitates the delivery of combined specialist and generalist care to patients with chronic respiratory disease in the community and improves symptoms and health status. The principles of the model are transferable to other conditions to improve overall health and reduce emergency hospital care.
Subject(s)
Pulmonary Disease, Chronic Obstructive , Quality of Life , Hospitalization , Hospitals , Humans , Patient Discharge , Pulmonary Disease, Chronic Obstructive/drug therapyABSTRACT
This article outlines the steps taken in a change management project to develop and implement a national caseload management framework for clinical nursing activities within public health nursing services in the Republic of Ireland. It involved the development of metrics, definitions, data collection resources and relevant written procedures. It was developed and implemented over a period of 12 months and involved the engagement and involvement of approximately 2000 frontline, management and administrative staff. Implementation was challenging due to the lack of software systems to collect and return data and support caseload management. Alternative IT-based data collection systems were identified, and work is ongoing to develop additional metrics and resources that will continue to support caseload management.
Subject(s)
Community Health Nursing/organization & administration , Public Health Nursing/organization & administration , Workload , Community Health Nursing/standards , Health Policy , Humans , Ireland , Models, Nursing , Nurse's Role , Public Health Nursing/standards , Quality Improvement , SoftwareABSTRACT
Across the world, there are concerns about how nursing and midwifery services are delivered in community settings. In the Republic of Ireland (ROI), significant economic contraction since 2009 has resulted in a decrease in the number of personnel available at a time when the older and younger population has been increasing. The purpose of this article is to outline a change initiative made in one public health nursing service in the ROI. In this change process, public health nursing staff moved from generalist to specialist roles. Distinct teams were created to deal with clinical care and child health, welfare, and protection. A key feature of the clinical team was the utilisation of a corporate caseload approach. The change was prompted by a reduction in staffing numbers, vacant caseloads, and increasing clinical risks and activity. Initial response to the change from frontline staff, management, and patients has been positive. The main effects of the change were noted in caseload management, risk management, and increased focus on clinical supervision. An external evaluation of the change initiative was carried out in 2014.
