Introduction
Pregnant women hospitalised with SARS-CoV-2 (COVID-19) have been more likely to be admitted to critical care, and to require caesarean section or neonatal unit admission for their baby.(1) A disproportionate number of those admitted to critical care have been from Black, Asian or Other Minority Ethnic (BAME) groups, overweight, obese, or had another relevant comorbidity.(1) Local Maternity Services have been asked to increase support for at-risk pregnant women, including BAME women.(2)
Virtual care and telehealth have been shown to improve outcomes in certain areas of maternal-foetal medicine and have been suggested as a means of breaking down barriers to access in prenatal care during COVID-19.(3–5) The National Clinical Director for Maternity and Women’s Health and the Chief Midwifery Officer for the U.K. have recommended home oximetry for pregnant women positive for COVID-19.(6) However, there have been few published examples of how this is accomplished in practice. A key challenge is the identification of sentinel events which predict deteriorations in clinical conditions. The number needed to treat is high: in the UKOSS cohort, the estimated incidence of hospitalisation with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2).(1) Each new COVID-19 variant brings new patterns of transmission, virulence and vaccine evasion, which alter national guidance and population behaviours. In turn, these change the frequency of sentinel events and the challenge for monitoring programmes. Maternity services need to continuously improve their programmes of support to hit this moving target. With variants of relatively high transmissibility but low virulence (such as Omicron), numbers of positive patients rapidly increase, and triage of virtual ward admissions become essential to avoid overwhelming capacity.
Norfolk and Norwich University Hospitals Trust navigated these challenges, by deploying a flexible Virtual Ward service to care for vulnerable populations during the pandemic. At first the Maternity Virtual Ward (MVW) was offered to all pregnant women with confirmed COVID-19. As volumes increased, a system of triage was developed to cope with demand. This short communication outlines the Virtual Ward technology, intervention and staffing model, readmission rates, as well as the specific triage criteria and alarm settings used, as an example of an operational model for other institutions.