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.