The Maternity Virtual Ward
The MVW coordinated care through the Current Health platform (Current
Health Ltd, Edinburgh, UK), and could monitor patients intermittently
with finger pulse oximetry (AM801 pulse oximeter, Med Linket, Shenzhen,
China) or continuously using the Current Health wearable. The Current
Health platform included a wearable and tablet given to patients, and a
web dashboard for the monitoring teams to view the patients’ vital signs
and their survey responses in real time. The wearable provided
continuous, clinical-grade measures of oxygen saturation, respiratory
rate, pulse, motion, and skin temperature, and could integrate with a
blood pressure cuff, axillary temperature patch and a spirometer. The
kit connected to the cloud via a home internet connection, or a 3G
network sim card for those without home internet. The web dashboard
displayed the patients’ observations in a format akin to the familiar
hospital observation chart. Alarms were set (Table 1) to alert
the team via push notification of any deterioration.
The MVW identified pregnant patients with confirmed-positive COVID-19
via three routes: discharge from hospital, direct contact from a patient
in the community, and positive swabs in the community (Pillar 2 of the
National Testing Strategy). Details of those with positive swabs were
supplied via a dataset from NHS England, and cross referenced with the
maternity database (E3, Wellbeing Software, Mansfield, U.K.). A midwife
from the MVW Team then called the patient for an assessment. All
patients continued in the MVW initially, but subsequently only patients
meeting any of the triage criteria in Table 2 were admitted, to
cope with increasing case numbers and target those who would derive most
benefit. Patients who did not require hospitalisation, or who did not
meet any of the MVW criteria were given isolation advice and signposted
to further help should they require it.
Once referred to the MVW, patients were called by a midwife every 12-48
hours depending on their level of risk. Their vital signs were monitored
either intermittently with the oxygen saturation probe or continuously
with the Current Health wearable, depending on the midwife’s judgment of
their baseline risk, symptoms, and clinical trajectory. Out of hours
monitoring was shared between the obstetric and MVW teams, and at peak
there were five midwives assigned to the service.
If alarms were triggered, or there were obstetric or other concerns,
patients were contacted then brought into hospital for review if
necessary. If patients were uncontactable, then the MVW team contacted
their next of kin or escalated to a community midwife for a home visit.
Patients were discharged after either 10 days in the virtual ward, 10
days from a positive test, or seven days from a positive test with
negative lateral flow tests on days six and seven. Consideration was
given to thromboprophylaxis at each stage. Growth scans were arranged 14
days post-Covid-19 detection for women who were severely or critically
unwell.