After less than a year in operation, the virtual COPD ward at Letterkenny University Hospital (LUH) has delivered benefits that far exceed initial projections, with significant reductions in COPD-related presentations to the hospital’s emergency department and readmission rates.

Since the commencement of the Community and Acute Respiratory Excellence (CARE) virtual ward in November 2023, there has been a 22 per cent reduction in overall admissions to LUH for patients with a presenting complaint of COPD.

The 30-day readmission rate for patients admitted with COPD has fallen from 27.8 per cent to 13.8 per cent.

According to the most recent figures from the HSE, 202 patients have been admitted to the virtual ward to date. Of these, 162 were treated for COPD exacerbations, equating to an estimated 880 acute bed days saved.

The CARE virtual ward is a nurse-led community-based programme, established in the Errigal chronic disease management (CDM) hub in Letterkenny, following a successful proof of concept in 2022. Patients are referred by their GP or directly from the hospital.

Patients are provided with bluetooth wearable technology to record respiratory rate, pulse and oxygen saturations. PMD Solutions’ motion-tolerant RespiraSense is incorporated to continuously monitoring respiratory rate.

RespiraSense measures the repetitive mechanical movement of breathing by analysing the movements of the chest and abdomen using piezoelectric film sensors.

The device processes breathing signals uses an algorithm to remove background noise not associated with breathing. If the respiratory rate changes and is outside of pre-set limits, the clinical team are alerted. This may necessitate an unscheduled clinic visit at the CDM Hub.

Although algorithms are incorporated into the system, the HSE stressed that artificial intelligence is not used to make clinical predictions and all data is reviewed by clinicians within the CARE pathway.

“We are identifying patients that have frequent exacerbations, [are] in and out of hospital, or in and out of their GP surgery, who are currently well,” LUH senior respiratory physiotherapist Therese Dooley said.

“We educate them. We teach them self-management and we teach them how to manage their condition at home. We also pre-empt exacerbations.

“There has been an overall reduction of 22 per cent in patients presenting to the emergency department at LUH with a presenting complaint of COPD. We have also had a reduction in our 30-day readmission rate from 27.8 per cent to 13.8 per cent, which have far exceeded the initial projects that we had made for CARE.”