Virtual Ward Inventor Responds to CARP Poll

Doctor's Kit

Senior Fellow of the Nuffield Trust, Dr. Geraint Lewis, who developed the original virtual ward in London, UK, sent the following comment in response to CARP virtual ward poll results:

“In September last year I had the Doctor's Kitopportunity to visit the Toronto post-discharge virtual ward. This was very exciting for me, since the project in Toronto was modeled on a similar project that two colleagues and I developed in London, England back in 2006. Both the London project and the Toronto project rely on two underlying principles: to identify which patients are at high risk of a future unplanned hospitalisation, and to offer these individuals preventive care at home using the systems, staffing and daily routines of a hospital ward.

It turns out that predicting which people are at risk of a future hospitalisation is not a simple matter. We know, for example, that doctors and nurses are unable to make accurate predictions. So both the London project and the Toronto project use a mathematical formula, known as a “predictive risk model” to identify patients. One of the key differences between the two projects is that the predictive model used in Toronto identifies patients at risk of a hospitalisation in the next 30 days, whereas the models used in the UK make predictions for the next 12 months.

The results of the CARP poll suggest that many Canadians are very enthusiastic about the Virtual Ward concept. I suspect one of the reasons for this is because the idea intuitively makes sense. Although we need rigorous evaluation to make sure that Virtual Wards are a wise use of health care resources, the results of the poll are also a reminder that many patients with complex medical problems report that they do not feel they currently have access to high-quality, team-based care in the community.

Some other impressive features of the Toronto virtual ward are the daily “ward rounds”, the robust scientific evaluation currently underway, and the fact that the staff is comprised of a combination of hospital and community staff. This mixture serves as a bridge between primary care and secondary care, helping to smooth the transition from hospital to home.

So although the Toronto virtual ward borrowed a concept from the UK, Dr. Dhalla and his colleagues have adapted and improved our original concept and I’m now confident that there are useful lessons for us to learn in the opposite direction across the Atlantic.”