Miriam Rigby Anthony Byrne Joanne Hayes Liz Hayles Development of an operational model for virtual palliative care ward in the community Miriam Rigby Anthony Byrne Joanne Hayes Liz Hayles

Outline Introduction to the virtual ward model Methods used to determine if virtual ward model would be suitable Discussion of components of virtual ward How the model would work in Cardiff

What is a virtual ward? Uses concept of hospital ward but based in the community Hospital ward components translated to the community setting

What is a virtual ward? (2) 100 patients per virtual ward Categorised according to need Patients visited and discussed at differing regular intervals dependant on need Chronic disease model – adapt for palliative care in the community in Cardiff

Virtual ward zones in Cardiff

Patient pathway and categorisation of patients Surveillance Coordination Wellbeing Integrated symptom management Robust care planning Family Support Complex Interventions EOLC Plans Rapid access to care Child and family preparation Bereavement support Advanced Disease Complex; EOLC Progression

Is a virtual ward suitable for a palliative care environment in Cardiff? Audit of referrals to Marie Curie Community Team Current patient distribution within Cardiff zones Does this fit the virtual ward model?

Referrals by zone 15 11 7 North West Central South East

Current distribution of patients in the zones 2 4 6 8 10 12 14 16 18 20 North West Central South East Zone Number of patients Red Amber Green

Population per zone Recommended one CNS per 50,000 population 10000 20000 30000 40000 50000 60000 70000 80000 90000 SE Central West North Zone Population Recommended one CNS per 50,000 population Work load of one CNS is 120 patients per year

Care Tracker

The virtual ward in Cardiff Agreed Standards Competencies Outcomes Informed choice and decision making Patient with changing need over time Community MDT: Specialist/Generalist Co-ordinated care Assessment Interventions Monitoring & review Wellbeing Programme Agreed frequency of assessment and review

Conclusions and further work Clarity of patient pathway, virtual ward, combination of the two Ownership rather than working in parallel – differences from hospice at home Is it economically sensible? How can the model be evaluated?