The frailty virtual ward is a team of specialist healthcare professionals supporting individuals at home who otherwise may require an acute hospital admission (hospital admission avoidance). We also facilitate early discharges through follow up at home. We provide clinical monitoring through acute illness and management of frailty syndromes.

Frailty virtual wards aim to help support individuals remain at home and to avoid risks associated with hospital admissions such as deconditioning. We also provide support to family/carers/loved ones who are caring for individuals at home.

We generally care for patients for up to 14 days.

Who we are; 

• Consultant geriatrician
• Frailty specialist nurses
• Occupational therapist/physiotherapist pharmacist

Types of patients we care for (not exhaustive); 

• Management of acute delirium +/- cognitive assessments
• Follow up of acute illness, symptom management and medication titration 
• Management of postural hypotension
• Falls risk assessments and risk management
• Medication reviews and polypharmacy
• Support with advance care planning and transitioning to end of life care

Need urgent advice? 
If urgent clinical conversation needed please call rapid access geriaction 07766 703 203

How do you know if some is admitted?
Encounters on HIE will show current patients as admitted to ‘Virtual care-elderly’ – information recorded here is live

Eligibility criteria

Inclusions

• Clinical frailty score 5+
• Aged 65+ (some exceptions made)
• Resident in Hackney

Exclusions

• Acute mental health crisis
• Where existing services are already providing the care requested

How to refer

The following clinicians can refer to this service: