Ailing at home

Since the Covid pandemic of 2020 and the national lockdown, a new expression has inserted itself into everyday English: Working from Home, or WFH. Now I have discovered that there is another: “Hospital at Home”, also known as “Virtual Ward”, and the acronym SMART.

SMART stands for Surgical, Medical and Acute Recovery Team. I had not heard of them before, and wonder how many readers have. For me, the discovery started when I was discharged from the Medway Maritime Hospital at the start of June, after a stay of eleven days suffering from jaundice. While much had been achieved while I was an in-patient, there were still a number of conditions which needed attention.

So it was decided to refer me to the SMART team—I know that’s two “teams”, but that’s what they call it—to continue my treatment at home. First I was given a nifty little rubberized suitcase. This contains a foam divider holding a variety of electronic gizmos and accoutrements.

A little case of …

At the hub of all this technology is what looks like a dated Samsung Galaxy mobile phone, equipped with a bespoke health application. This enables instant connection with the Team.

Next is a pulse oximeter. If you’ve been to the doctor’s or to hospital, you’ll know what one of these is. It’s the baby crocodile which the nurse clips, usually to your forefinger, to measure your pulse and the saturation of O2 in your bloodstream. Only, this one you have to wear practically all the time. If you have the temerity to take it off, or separate it from the phone, you’re very likely to receive an urgent enquiry from one of the team, wanting to know why your heart appears to have stopped beating.

In addition to a bluetooth-enabled blood pressure cuff, the weightiest bit of kit is a digital bathroom scale to weigh yourself each morning. To my enormous delight, it’s set to kilograms, which I use at home anyway, and requires the patient to enter their morning, and optionally their afternoon weight in kilos.

24-hour meds

All the above was for the regular observations, which the patientis rquired to report twice daily, once before 10 in the morning, and once before 4 in the afternoon. In addition, I was fitted with a device delivering medication through a central line in my right arm. It was a bit like an i.v. drip, but much smaller, and was clipped to the front of my shirt.

“Just a tiny scratch”

From time to time, a member of the Team would make an appointment to come on a visit, principally to take a blood sample for analysis. Sadly I am blest with uncooperative veins, as a result of chemotherapy twenty-plus years ago, which has left the blood vessels in my arms knotty and shy. There was one occasion when the nurse got through five cannulae (cannulas) before she was able to draw a full amount of blood.

Not alone

My first thought on encountering this service was that it was very new and almost, if not entirely, unique. However, on questioning en.wikipedia.org/wiki/H… I discovered that the concept and practice of Virtual Wards have been around since the end of the last century in some cases. However, they received a massive boost in 2020, when the COVID-19 pandemic put an enormous strain on hospital admissions.

Initially the service was restricted to 9-to-5, due to limited availability of staff. Currently, at least at Medway Maritime, the cover is 24 hours per day, seven days per week.

Virtual Wards: a win-win

Contemplating my experience of “Hospital at Home”, I identified a number of real benefits, both to the patient—i.e. me—and the hospital. First, I was not blocking a bed required by a patient in more urgent need. Second, a lot of the monitoring could be done by team members from home. Indeed there was one day when I was being checked on by a guy who told me that he was at home, about ten miles west of Durham City.

I had the immense advantage and great pleasure of sleeping in my own bed, eating my wife’s delectable cuisine, and having access to my computers, the television and my books.

Let’s hear it for Virtual Wards !

At the height of the COVID-19 pandemic we were all encouraged to come out nightly and applaud the front-line workers in the NHS. I believe that members of the SMART teams up and down the land are deserving of as big a hand as anyone. “Thank you for your service.”