Abdelhamed Haram, Muhammad Javid, Carolyn Cullinan, Patricia O’Gorman, Christina Fleming, Colin Peirce
Background: Virtual ward provides hospital-level care in the community, reducing inpatient length of stay while maintaining clinical safety. The Health Service Executive (HSE) Virtual Ward at University Hospital Limerick (UHL) currently supports medical, respiratory, cardiology, gynaecology, orthopaedic, and intravenous (IV) pathways. With increasing pressure on surgical bed capacity, this project aimed to evaluate the feasibility of extending virtual ward services to selected general surgical patients.
Methods: A feasibility review was conducted using existing virtual ward standard operating procedures (SOPs), analysis of current patient flow, and assessment of resource availability. Inclusion and exclusion criteria, governance arrangements, and operational constraints were reviewed to determine suitability for surgical integration. Surgical diagnoses considered appropriate for virtual ward care included acute cholecystitis, gastritis, uncomplicated diverticulitis, and cellulitis, as well as patients requiring IV antibiotics outside the Outpatient antibiotics therapy pathway.
Results: The virtual ward demonstrated adequate capacity (25 slots plus 5 weekend imaging slots) and established infrastructure to support selected low-risk surgical patients. Key enablers included twice-daily remote monitoring, access to nurse-led clinical review, and an existing IV therapy pathway. Challenges identified included limited dedicated slots for surgical patients, variable consultant availability across the UHL Group, radiology prioritisation issues, and the need for timely medication reconciliation. Governance was established under the supervision of a dedicated consultant general surgeon. Three core requirements were identified to ensure safe implementation: (dedicated surgical oversight to maintain clinical continuity, reserved radiology access for virtual ward surgical patients, and allocation of defined virtual ward slots for surgery to ensure reliable patient flow.
Conclusions: The introduction of a virtual ward pathway for general surgical patients at UHL is feasible and aligns with national strategic goals to optimise bed utilisation. Addressing governance, radiology access, and the allocation of surgical capacity will be essential to ensure safe and sustainable integration. Further departmental review and approval are recommended before implementation.
