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.