Beds in virtual wards use four times less carbon than a traditional inpatient bed, so helping the NHS achieve its net zero target by 2045. That is the conclusion of a pioneering study that was published today (18 June) in the open access journal BMJ Innovations.
The paper’s first author is Kate Townsend from the London-based NHS England and NHS Improvement South East, who co-wrote the article with four colleagues.
Dr Townsend and her colleagues suggest that virtual wards represent a promising way to care for more patients, with the potential to reduce the need to build more high-carbon impact hospitals. They compared the carbon cost of virtual ward care with that of traditional inpatient care from May 2022 to May 2023 in a large acute hospital trust.
The researchers quantified the avoided carbon emissions for 1,260 virtual ward patients, 728 of whom were frail and 532 of whom had an acute respiratory infection. They used the Greener Care at Home toolkit to calculate the carbon emissions of a care pathway, including carbon activity points, such as accident and emergency attendance, travel to hospital in an ambulance/car, and diagnostics.
All inpatient bed days, virtual ward bed days, home energy and community/general practice (GP) call-outs were calculated initially for a random sample of 30 patients, using a manual audit and then for the entire group of 1,260 patients, using an internal data collection system.
Virtual wards’ impact is ‘significant’
Dr Townsend and her colleagues used a previously created method to calculate ‘predicted stay’ in hospital for the virtual ward and traditional inpatient care pathways.
The results show that there was a significant difference between the carbon costs of a virtual ward and an inpatient stay, with virtual wards emitting significantly less carbon when evaluated across the entire episode of care.
On average, an inpatient bed emits four times more carbon (at 37.9 kg CO2) than a virtual ward bed day (at 8.8 kg CO2). The carbon emissions avoided added up to 285 tonnes of CO2 between May 2022 and May 2023.
‘As our population increases, we will need to create more effective, less resource-intensive ways to treat our local population, without having to build more hospitals as this is extremely high cost, high carbon, and will require additional workforce’ [Kate Townsend]
Caveats and conclusions
While this does not represent a carbon reduction for the hospital – as hospital beds were still in use by other patients – it does represent increased capacity, the researchers emphasise.
The reduced carbon footprint of virtual wards is particularly important as the NHS aims to deliver 40-50 virtual ward beds per 100,000 of the population, say the researchers.
‘Having a [virtual ward] in place will not decrease overall carbon emissions for the hospital but enable more patients to be cared for in the most efficient and lowest carbon way possible, enabling the hospital’s capacity to increase and for teams to manage more patients with the same number of inpatient beds,’ Dr Townsend and her colleagues write.
Carbon costs were higher, using the manual audit, largely due to the addition of external factors that internal hospital data systems don’t capture, they suggest.
The team acknowledges that lacked data on carbon emissions from typical home use, and relied instead on government calculations, which estimate average home carbon emissions of 7.4 kg CO2/day. Nor do patients always fit into a neat box of a mapped pathway, which highlights the complexity of carbon mapping care pathways, they point out.
Nevertheless, Dr Townsend and her colleagues conclude: ‘[Virtual wards] look like a promising way for hospitals to increase capacity in a model of sustainable healthcare that aligns with the triple bottom line analysis of high-quality care, value for money, and low associated carbon emissions.’
They add: ‘We know that a traditional inpatient bed is a very high carbon/resource intensive method of treating patients. As our population increases, we will need to create more effective, less resource-intensive ways to treat our local population, without having to build more hospitals as this is extremely high cost, high carbon, and will require additional workforce.’
Fact file
Virtual wards – also known as ‘hospital at home’ – provide hospital-level care to patients in the comfort of their own homes, leveraging digital technology and remote monitoring.
In recent years, particularly in the wake of the Covid-19 pandemic, virtual wards have been widely adopted throughout England to ease pressures on hospital bed capacity and streamline patient flow, say the researchers.
But while existing research has focused mainly on the care outcomes and cost effectiveness of virtual wards, few studies have looked at their environmental impact and carbon footprint.
To access the full version of the article – titled Exploring the carbon impact of virtual wards in a large acute hospital Doi: 10.1136/bmjinnov-2024-001347 – see: https://innovations.bmj.com/lookup/doi/10.1136/bmjinnov-2024-001347
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