Analysis

Virtual children’s ward brings the hospital into the home

Lead nurse Zoe Tribble believes she manages a unique service. She oversees four other nurses in a team of outreach workers who deliver a ‘virtual ward’ service to babies and children in their own homes who would traditionally have had to stay in hospital. There are other teams that do a similar job, but none manage it from 7am-11pm every day of the year and can complete three visits a day to patients, Ms Tribble argues

Lead nurse Zoe Tribble believes she manages a unique service. She oversees four other nurses in a team of outreach workers who deliver a ‘virtual ward’ service to babies and children in their own homes who would traditionally have had to stay in hospital.

There are other teams that do a similar job, but none manage it from 7am-11pm every day of the year and can complete three visits a day to patients, Ms Tribble argues.

She works for a private company, Healthcare at Home, which has a contract to partner King’s College Hospital NHS Foundation Trust to deliver treatment to babies and children aged 0-18 years with conditions such as meningitis or sepsis.

This usually involves administering antibiotics via a bolus injection or syringe driver, although nurses sometimes give drugs such as heparin to prevent blood clots. During these procedures the nurses monitor the child’s blood pressure, temperature and pulse rate.

Healthcare at Home lead nurse Zoe Tribble, right, visits Maxwell in his home. Picture with consent

Picture credit: Barney Newman

‘Children get to be in their own homes, have better nutrition because they are not eating hospital food, and sometimes can go to school,’ says Ms Tribble.

She adds that the team saved 1,013 bed days for King’s College between its starting date of April 2014 and September 2015.

‘We don’t have borders as such, although the furthest we usually travel is to Thamesmead or Croydon, which are about ten miles from our base in King’s College Hospital, south London,’ says Ms Tribble.

Visits aren't long

‘One patient we had was two weeks old and came into hospital with bacterial meningitis. He was in hospital for 11 days and then we went to his home three times a day to give intravenous antibiotics. The visits aren’t long – it only takes about 30 minutes to give the bolus injection. Within the house the baby’s family can be with him, which isn’t always the case in hospitals. Most hospitals don’t allow siblings to come in because there’s an infection control risk.’

This help for families is crucial. They don’t have to take time out of work to visit their children in hospital, which can also be expensive with car parking costs. The children themselves feel safer and happier when they are at home with their families rather than in a hospital, says Ms Tribble.

Links with consultants

Nurses have links with paediatric consultants at the hospital and can call for advice. Sometimes a child might be recalled to hospital and very occasionally an outreach nurse has to call an ambulance.

Ms Tribble says: ‘Only once have I had to call an ambulance. It was for a baby with an infection who was breathing quite fast. After advice from a doctor we brought the baby in, but he was okay by the time he got to hospital.’

The antibiotics and other medications are usually kept at the patient’s home, often in the form of powder stored in vials. Nurses take equipment such as thermometers, pulse oximeters and syringes with them. Sometimes nurses go out in pairs, but usually only one of the team is needed for a home visit.

Daunting

Lone working such as this can be a challenge, says Ms Tribble. ‘It can be quite daunting for some nurses who have worked in a hospital but then move into care at home. You have to make clinical decisions without support.’

Ms Tribble adds: ‘We have a protective alarm device that we carry with us. Someone monitors our location and our conversations and if they think we are in trouble they send the police around.

Contract

‘It started out as a pilot but the trust decided to extend it because it was working so well. The contract will go out to tender each year, but we are confident we can keep winning it because no one else is giving the kind of service that we do. We may also offer a specialist service to neonates. At the moment, a lot of these babies just sit in hospital.’

The trust did not wish to say how much the contract is worth, saying that this was ‘commercially sensitive’.

Outreach teams for adults have been common for some years, but trusts have been slower to create similar teams for children, largely because it can be difficult to find the expertise to deliver care to this patient group.

Senior sister on the medical ward at King’s College Hospital Laura Bufton says: ‘These are children who don’t need a huge amount of medical or nursing input, so they will get better quickly in their own homes.

Normal lives

‘If the family is suitable for the outreach team, the doctors order the medication for them to take home and the outreach team is booked to visit to go through the plan of care with the family. Being at home means they can eat and drink normally, play and get back to their normal lives.’

Despite the reduced number of children staying in hospital, Ms Bufton has not seen an easing of her workload. ‘There are always more patients to take the beds.’

Ms Bufton adds: ‘The number of children we refer to the outreach team varies. Some weeks there are quite a few and sometimes none at all.

Direct referral

‘Sometimes we go to the emergency department to meet families and they can be referred directly to the outreach team without even being admitted to the hospital. The outreach nurses send the results from observations back to us and report to us if the parents have any concerns. The consultants discuss all the patients each day.

‘It helps us that we’ve got to know the outreach nurses. At the beginning Zoe came and chatted to the nurses in the hospital about how to do the referrals, what to do when, and when to order medicines.’

Ms Tribble says that families have given good reports about the service so far. ‘The feedback has been phenomenal. We give out a satisfaction survey and every respondent so far has said they would recommend it to their family and friends.’

 

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