Virtual medicine ward may be just what the doctor ordered to reduce ER overcrowding

Of all the health-care ideas this government has rolled out in recent months — some bold, some half-baked, and some purely aspirational — the revival of Manitoba’s virtual medicine ward is one of the few that will make a meaningful dent in hospital congestion.

It won’t solve ER overcrowding on its own. Nothing will. But by freeing up scarce medical-ward beds, it addresses one of the root problems that drive excessive waits in emergency departments: nowhere to put admitted patients.

This is one of the rare times where the province is taking a page from other jurisdictions — Quebec, Ontario, B.C., and even countries such as the U.K., Australia and New Zealand — that have been safely treating certain patients at home for years.

In fact, some nations have been doing this for more than two decades. Manitoba tried it during the pandemic, shelved it and has now brought it back.

The premise is simple: if a patient is stable enough to safely finish their recovery at home, even if they require oxygen, IV antibiotics or close monitoring, why keep them in a crowded hospital ward? Why not turn the patient’s living room into a monitored extension of the hospital — with real-time vitals, daily check-ins and paramedics on standby — while keeping an actual bed open for someone who needs it?

That’s exactly what Winnipeg hospitals are now doing, and early results suggest the program is already freeing up meaningful capacity.

Since September, 15 patients from the Health Sciences Centre, St. Boniface, Grace and Concordia hospitals have used the virtual ward, freeing up the equivalent of 90 in-patient bed days. The program can handle 30 patients at a time and is expected to grow. Only three people have had to be taken back to hospital.

Patients are sent home with a tablet and connected medical equipment — pulse oximeters, blood-pressure monitors, oxygen if needed — while doctors and nurses monitor them via Zoom seven days a week.

Most virtual care runs from 7:30 a.m. to 7:30 p.m., with community paramedics picking up the slack overnight. If bloodwork is needed or an IV must be connected, paramedics go to the home.

These aren’t people being shunted out the door in a cost-saving rush. These are patients who would otherwise remain in a hospital bed for several more days, receiving the same medical treatments they can now get from their couch.

Instead of tying up hospital space, they’re recovering at home while still connected to clinical teams. Studies in other jurisdictions show the majority of patients who voluntarily signed up for the program had high satisfaction rates.

The province has hired four nurses specifically for the virtual ward, with another nursing position and three clerks still to come. It’s a small investment compared to the millions of dollars required to add even a handful of new in-patient beds. And it’s far cheaper — and faster — than building new hospitals, something health systems worldwide try to avoid.

Not every patient will be a candidate for virtual medicine wards. Their level of acuity will be a major factor. But there may be other challenges for some in accessing this service, including language barriers, unfamiliarity with the use of technology or homes that are not suitable for recovery. In most cases, patients need Wi-Fi in their homes to communicate virtually with medical staff.

Still, many patients will be able to recover at home. And the more the program grows, the less pressure there will be on ERs and medical wards.

Will virtual wards eliminate ER waits? Of course not. Even jurisdictions that use them extensively still struggle at times. Emergency congestion is a multi-factor problem — doctor shortages, home-care gaps, delayed long-term care placement, population aging and chronic under-capacity across the system.

But virtual wards directly address what ER doctors call “access block” — when admitted patients can’t move to a ward because no beds are available. That backup pushes up ER wait times.

So anything that increases ward capacity will, by definition, reduce ER bottlenecks.

Health Minister Uzoma Asagwara highlighted the patient-focused side of the program — giving people care in the comfort of home while maintaining a safety net. That’s true, and it’s politically appealing.

None of this means the government has solved hospital overcrowding — not even close. Serious investments in staffing, primary care and long-term care are all still needed. Paramedic shortages remain a critical threat.

But give credit where credit is due: reviving and expanding virtual medicine wards is one of the smartest moves Manitoba has made in years. It’s evidence-based, patient-friendly, fiscally responsible and aligned with best practices in other provinces and around the world.

For a health-care system chronically short on good news, this is one change that deserves applause and, more importantly, expansion.

tom.brodbeck@freepress.mb.ca