How Singapore created virtual wards for Covid-19 patients

By Sean Nolan

Singapore’s National University Health System developed a hospitalisation-at-home system through wearable devices and telehealth.

“Home is where the heart is” seems like an uplifting statement, but it's also a call to action for hospitals. When patients are being treated at home, they require the same level of care in their bedroom as they would in a clinic.

This was the challenge facing Singapore’s healthcare organisations. Singapore’s National University Health System (NUHS) adopted a virtual wards system to care for Covid-19 patients remotely.

Clinicians from NUHS share how virtual wards have saved patients more than five thousand overnight stays in the hospital. They explain why a virtual wards system may prove vital to addressing future challenges.

What is a virtual ward?

NUHS’ virtual wards enable Covid-19 patients to recover at home, given that their condition doesn’t require hospitalisation. Doctors and nurses monitor the health of these recovering patients in two ways.

First, patients or patients' families will speak with caregivers every one to two days through video or audio calls. This call could include an examination, where patients are required to perform a simple exercise like standing up and sitting down.

This is where the second form of monitoring comes in. Wearable devices allow NUHS  to monitor patients’ blood oxygen levels, temperature and pulse rate while they recover at home.

If patients’ oxygen levels drop after this exercise, this could indicate Covid-19 is affecting a patient's lungs, explains Dr Stephanie Ko, Clinical Lead for NUHS@Home and NUHS Covid-19 Virtual Ward.

A chatbot sends patients a reminder three times a day to input their vital signs into an online form. Less tech savvy patients or those without mobile devices receive wearable tools that automatically record and share this data, Ko highlights.

If the vital signs data shared with NUHS are beyond the usual limits, indicating ill health, NUHS staff will be notified so they can follow up, she adds.

Looking to the future

This healthcare-at-home approach frees up beds in hospitals, and could be part of “key strategies” for future pandemics, Ko predicts.

Virtual wards may also help healthcare organisations to manage Singapore’s ageing population. This trend, and an increasing demand for hospital beds, prompted Dr Ko’s team to explore alternatives to hospitalisation in a physical ward.

The wards are helping to “redesign Singapore healthcare towards a shift from hospital to the community”, she says. This means taking healthcare demands from hospitals, and transferring them to homes and local clinics for example.

The concept of virtual wards is well-established in Australia, the UK, and the US, Ko shares. It enables patients to receive treatment “within the comfort of their own homes, and reduce the risk of exposure to hospital-acquired infections”, she explains.

The OneNUHS app is another initiative to promote this shift to healthcare in the community. Its telehealth feature allows patients and their families to teleconsult with their specialists via video call, GovInsider wrote.

The impact on staff

Virtual wards can boost the work of healthcare staff, Ko highlights. They enable staff to care for the same number or even more patients compared to physical wards, she adds.

A junior doctor would usually care for 20-25 patients, and 1 nurse would care for 40 patients, in the virtual ward.

When the monitoring system records abnormal vital signs, it will send a push notification to the attending clinician. This enables them to “monitor a large number of patients simultaneously”, she explains.

Telehealth also reduces the amount of travelling to patients’ homes. Nurses are not required to record vital signs in person, meaning they can conduct in-person visits only where needed, says Yeo Ai Wah, Senior Nurse Clinician, Advanced Practice Nurse, CareHub, Regional Health System Office, NUHS.

Virtual wards are part of a revolutionary rethinking of hospital care. Not only do they form part of Singapore’s response to Covid-19, but they could be here to stay for the nation’s future health challenges.