The paediatric virtual ward team at Sandwell and West Birmingham NHS Trust and Docobo have successfully implemented a remote monitoring-enabled virtual ward for children with nephrotic syndrome, which supports children and families at home, managing symptoms while in relapse until remission is achieved.

The paediatric virtual ward team at Sandwell and West Birmingham NHS Trust and Docobo have successfully implemented a remote monitoring-enabled virtual ward for children with nephrotic syndrome, which supports children and families at home, managing symptoms while in relapse until remission is achieved.

The project, which began in September 2023, supports children and families to manage their symptoms in relapse until remission is achieved  while in the comfort of their own homes. The paediatric virtual ward team empowers patients and families and the project had saved 173 bed days by March 2024, equating to an equivalent cost saving of £86,000. The hospital now provides eight pathways for children and has received excellent feedback from families and young patients, consistently meeting and exceeding national targets for virtual ward capacity.

This case study highlights the innovative use of technology by Sandwell and West Birmingham NHS Trust and Docobo to improve care for children with nephrotic syndrome, demonstrating significant benefits in patient experience, efficiency and cost savings.

Background – the need for remote monitoring

The team at Sandwell and West Birmingham NHS Trust wanted to introduce remote monitoring for children with nephrotic syndrome – a condition which affects a child’s renal system and which requires frequent monitoring once the child is stable. Before remote monitoring, children would be discharged once haemodynamically stable, often without further home support. This would mean children would have to visit the hospital daily for blood pressure readings, disrupting family life and work schedules, while visits had to be squeezed into a narrow 1-2 hour window.

The team wanted to implement a virtual ward with remote monitoring to allow readings to be taken at home, which would fit around families’ schedules and reduce the need for daily hospital visits.

The resulting technology is enabling stable children to be monitored at home – empowering families and patients, providing flexibility and enhanced sustainability by eliminating travel needs, freeing up hospital beds and avoiding unnecessary admissions.

What happened

When the local ICB rolled out Docobo remote monitoring across the Black Country, the team at Sandwell identified a need to implement the technology and took valuable insights from the paediatric virtual wards at Dudley.

Stakeholders, including the medical team and inpatient unit, were consulted to assess how the technology could optimise their time and resources.

The project was a collaborative effort with Docobo, whose Careportal devices were integrated with the community system SystmOne and the inpatient system Unity. This partnership facilitated home management of complex cases, repeat tests, and prescription administration via iPad.

Goals were set in the project planning phase and Docobo provided question sets and updates, enhancing the system by incorporating new input and output features, including weight monitoring. All necessary information is now readily available on the platform. Docobo introduced sliding scales to track factors like fluid intake, urine output, and more, making the system more comprehensive and effective. The technology uses set questions and times that fit around schedules, allowing for flexibility and reducing interruptions to daily life.

The team worked collaboratively in order to streamline information access and improve monitoring through sliding scales for fluid intake, urine output, and other factors. Docobo provide question sets, updates, and new features like weight monitoring, making the system comprehensive.

The team at Sandwell and West Birmingham NHS Trust were actively engaged in designing and implementing the project, ensuring that the system met the needs of both patients and healthcare providers.

Ruth Hartland, Clinical Nurse Specialist, Paediatric Virtual Ward at Sandwell and West Birmingham NHS Trust heads up the team and has been involved in the project since the beginning. ‘This collaborative effort has resulted in a user-friendly and effective solution, which is improving patient and staff experiences alike. Docobo’s responsive support ensured a smooth setup and operation. This approach also facilitates hospital avoidance, ensuring a more efficient and effective use of resources.’

How does it work?

Children who have been assessed on the Paediatric unit and who are stable now have the option to be transferred to the Virtual Ward for ongoing home care. Before leaving the hospital, families and children are given Docobo devices and training to enable them to measure vital signs when at home – which are transferred automatically to the virtual ward. Any anomalies are picked up by the clinical hub who monitor the readings. Families complete observations and answer questions for the virtual ward team, who update the medical team as needed.

Ruth says: ‘We can now manage most complex cases at home, conducting repeat blood and urine tests, and administering prescriptions via the iPad. Docobo provides all the necessary equipment and we simply make a phone call to set up. If there are any clinical concerns, the team can contact the families directly. This approach has proven very successful has enabled us to manage frequent relapsing patients at home, preventing unnecessary hospital admissions. It has also saved time and is increasing sustainability by eliminating the need for travel.’

Outcomes and Impact – Efficiency and Care Improvement

Since its launch, the virtual ward has supported 32 children with nephrotic syndrome, saving 173 bed days by March 2024. The capacity has increased from 8-10 funded beds to accommodating 14-16 patients, often exceeding national capacity targets. This transition allows for better acute patient flow and effective management of frequent relapsing patients at home, reducing hospital admissions.

Benefits for families and patients

The remote monitoring has significantly improved the patient experience, allowing children and families to manage their care at home, reducing hospital visits, and enabling families to maintain their daily activities.

Feedback from families has been extremely positive, highlighting improved patient journeys and independence. An example includes a 15-year-old managing her care at home for two weeks without hospital admissions, reflecting increased confidence and satisfaction.

Benefits for teams

The virtual ward has transformed both patient and staff experiences, streamlining workflows and reducing administrative tasks for staff. It has allowed the team to manage more patients with existing resources and has been recognised locally, reflecting the team’s commitment to continuous improvement.

The streamlined processes, improved patient management and enhanced patient care demonstrate the technology’s potential for spread across the healthcare system.

The project has yielded additional benefits, such as enhanced family education, while the hybrid approach of remote monitoring and home visits has improved patient care while reducing environmental impact by eliminating unnecessary travel.

Ruth says: ‘The technology empowers families to care for their children at home, providing daily support from the paediatric Virtual Ward team until remission is achieved, leading to improved service delivery and better patient care.’

Financial Impact of remote monitoring

The project has demonstrated substantial cost savings, with potential savings of over £86,000 by March 2024. This improved efficiency and resource utilisation showcase the financial viability of the technology.

Ruth continues: ‘Docobo has been a responsive and collaborative partner, updating question sets and refining the system based on feedback. The project reflects a genuinely co-produced service, with ongoing feedback from patients, clinicians, and families shaping its development and implementation.’

Adrian Flowerday, Managing Director at Docobo says:

We have really enjoyed working with the team at Sandwell and West Birmingham NHS Trust. This has been a really collaborative partnership and to have successfully implemented the remote monitoring-enabled virtual ward for children with nephrotic syndrome so quickly and efficiently is really impressive. The resulting paediatric virtual ward is supporting children and families at home to manage symptoms while in relapse until remission is achieved and is empowering patients and families, saving an impressive number of bed days and preventing unnecessary hospital admissions. The virtual ward is improving patient experience and outcomes and we are proud to be working with the team on this fantastic project.

The technology empowers families to care for their children at home, providing daily support from the paediatric Virtual Ward team until remission is achieved, leading to improved service delivery and better patient care. Ruth Hartland Clinical Nurse Specialist, Paediatric Virtual Ward at Sandwell and West Birmingham Hospitals NHS Trust.