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NICE Backs Home Monitoring for Acute Respiratory Infection

People in England with an acute respiratory infection (ARI) could be monitored from their own homes using technology platforms that feed back vital information on their condition to clinical staff, the National Institute for Health and Care Excellence (NICE) said.

The draft guidance came after NICE was asked to assess virtual ward technologies to help manage capacity in the NHS. People with an ARI accounted for a significant proportion of people needing urgent care from their GP or hospital, NICE acknowledged.

"The NHS is under pressure and giving people with an acute respiratory infection the chance to be monitored from the safety of their own home or care home can help manage capacity in hospitals," said Mark Chapman, NICE's interim director of medical technology and digital evaluation.

Virtual ward — also known as 'hospital at home' — platform technologies comprised three components. These are: 

  • A patient-facing app or website
  • Wearable medical devices for measuring vital signs
  • A digital platform for healthcare professionals

A patient's temperature, heart rate, oxygen saturation, blood pressure, and respiratory rate could be monitored and fed back to healthcare professionals, often automatically. "Evidence shows virtual wards are safe and can be an option for those who are comfortable using technology to have their condition monitored away from a hospital ward," said Mr Chapman.

Guidelines Call for More Evidence to be Generated

NICE said that virtual ward platform technologies could be used in the NHS — while more evidence is generated — to monitor people over 16 with ARI in their usual place of residence. Such technologies would be suitable for patients who had been referred for hospital admission, or who were stable or improving following their admission to hospital but required ongoing monitoring.

There is an "increased demand" on NHS services due to respiratory conditions, emphasised NICE, which highlighted that ARI hubs and ARI virtual wards had already been established to relieve pressure on the service, and that the digitisation of virtual wards allowed for "scalability".

Evidence presented to the independent committee showed there were "similar outcomes" for patients who were treated in hospital compared with those on a virtual ward, and that people admitted to virtual wards were comfortable using the technology once they had been trained by a healthcare professional.

Cost Savings

The regulator estimated that virtual ward technologies could save around £872 per person compared with inpatient care, and £115 per person compared with care at home without a technology enabled virtual ward. However, there was still some uncertainty over how much the NHS might save using virtual wards, so further evidence would be generated over the next 4 years to establish the benefits in practice, NICE said.

The committee said further evidence needed included the length of virtual ward or hospital stay, hospital admission and readmission rates, the number of contacts with other healthcare providers, such as GP visits, home visits, and calls to 111, and the experience of using the technologies for patients and carers.

"Using these innovative new technology platforms within a carefully managed NHS environment will enable us to generate the evidence to understand the benefits to patients and the wider health system of using virtual wards," explained Mr Chapman.

Patient Choice Remains Paramount

NICE reassured that admittance to a virtual ward would take place after shared decision-making conversations between the patient, their carers, and the clinical team. Patients and/or their carers would also need training and the confidence, motivation and skills to be able to use a virtual ward platform and the associated medical devices in their homes.

"Some people may choose not to be on a virtual ward or may not feel comfortable using the technology and may prefer treatment in hospital," acknowledged NICE. "Everyone has the right to make informed decisions about their care," the regulator stressed.

Asked to comment for Medscape News UK, Sarah MacFadyen, head of policy and external affairs at Asthma + Lung UK, cautioned that whilst virtual wards had a lot of potential to help people with respiratory infections at home, and to reduce pressure on the NHS, it was "crucial that people can choose, where possible, where they would like to be treated, and are able to escalate concerns whenever they feel necessary". 

If not implemented properly, there was a risk of virtual wards leaving patients feeling "abandoned" or putting additional pressure on community services, she warned.

"If someone is struggling with self-monitoring, this should not be ignored," urged Ms MacFadyen, "as it is not the right form of treatment for everyone, and home tech and health literacy barriers should be considered with every referral."

NICE early value assessment guidance applies to England only. The consultation runs until Friday 1 September 2023.

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