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Respiratory Hospital at Home (Virtual Ward) Inclusion & Exclusion Criteria

Acute Respiratory Hospital at Home (Virtual Ward) Inclusion & Exclusion Criteria

The Pathways covered:

  1. COVID suspected or confirmed.
  2. Suspected or confirmed respiratory infection.
  3. Early supported hospital discharge for those with underlying lung disease, predominately COPD.
  4. Safe Admission Avoidance from within BHT ED/SDEC, or referrals received from Buckinghamshire GP registered patients, paramedics or self-referrals (self-referrals need to have previously been cared for by BIRS and have a confirmed diagnosis of COPD).
  5. Patients occupying inpatient BHT beds that are medically fit for discharge but are still requiring oxygen therapy.

For pathways 1-4 ONLY:

Subject to a clinical judgement, the following criteria may support identification of patients suitable for admission to an ARI virtual ward: 

Inclusion criteria

  • Patient aged 18 or over.
  • Named consultant.
  • Suspected or confirmed respiratory infection including COVID-19.
  • Oxygen saturations of 95–100%, NEWS2 <3, clinically stable and/or improving.
  • Known chronic respiratory disease.

Patients with the following clinical features may also be considered, where clinically appropriate:

  • Oxygen saturations of 93–94% and/or NEWS2 3 or 4 with improving clinical trajectories (in patients being discharged from hospital-based acute care).
  • Oxygen saturations of 88–92% (or baseline) if known chronic hypoxia, e.g. chronic obstructive pulmonary disease (COPD).
  • Frail patients (based on Clinical Frailty scale) should not be excluded but the dedicated BHT frailty virtual ward may be more appropriate.
  • Pregnant women with saturations >94% should not be excluded and early maternity involvement should be sought for specific advice around management of suspected ARI including COVID-19 in pregnancy. This group MUST have a named respiratory and obstetric consultant for safety netting.

Additional inclusion criteria onto ARI for confirmed or suspected COVID-19 ONLY:

  • Where clinically appropriate patients with oxygen saturation of 92% or lower or experiencing moderate to severe shortness of breath are unsuitable for early supported discharge unless the patients are stable and, this is their usual baseline saturations. These patients must be seen by the In-Reach Respiratory Consultant (if not on a BHT COVID Ward).
  • Discharge may be considered suitable in stable patients with mild exercise desaturation (>3% from baseline) who have been fully investigated and otherwise have resting saturations >93% on room air.

Exclusion criteria

Patients with the following clinical criteria should be excluded:

  • Anyone under the age of 18 to be managed by the paediatric services.
  • Unstable or worsening clinical trajectory, e.g. saturations <93% unless confirmed baseline and/or NEWS2 ≥5.
  • severe or life-threatening presentations of pneumonia, asthma or COPD.
  • suspected sepsis.
  • chest pain that is concerning or a serious cause requiring immediate hospital transfer, e.g. acute coronary syndrome.
  • pregnant women with saturations of ≤94%.
  • Postpartum up to 6 weeks.


For pathway 5 ONLY

(ie. Oxygen wean in the community setting)
Subject to a clinical judgement, the following criteria may support identification of patients suitable for admission to an ARI virtual ward:


Inclusion Criteria

  • Patient aged 18 or over.
  • Named consultant.
  • Persistent hypoxemia at rest on room air. Target SpO2 will be agreed by referring consultant/medical team on a case by case basis.
  • Suitable for oxygen at home (risk assessment undertaken by BIRS@BHT.
  • Improving clinical trajectory in the last 48 hours – (symptoms, baseline function and oxygen saturations).
  • No fever for 48 hours consecutively without medication to reduce fever.
  • NEWS2 stable 0-4.
  • Oxygen weaning during in-patient stay has already been initiated.
  • Registered with General Practitioner.
  • Medically stable.
  • Has the mental capacity to consent to treatment or treatment is deemed in patient’s best interest as per the Mental Capacity Act (10).
  • Follow-up appointment(s) arranged if required prior to referral.
  • Any social care arrangements organised prior to discharge.

Exclusion Criteria

Patients with the following clinical criteria should be excluded:

  • Patient aged below 18 years.
  • Unable to cope at home.
  • Cyanosis, confusion, breathlessness with RR>25/minute, temperature>38 degrees Celsius.
  • Type 2 respiratory failure, suggestive of underlying condition.
  • 02 flow rate’s above 5l.min either via MC or venturi mask due to selection of community equipment.
  • Lacks mental capacity to comply with treatment.
  • No clear respiratory plan.
  • No follow-up arranged.
  • Unmet social needs: – Patients must be able to self-manage at home or have adequate family support or support in the community setting.
  • Patients requiring End of Life Care or those actively dying – this group can still be referred for home oxygen support via BIRS as it would not be deemed suitable to wean this group off their prescription of oxygen.
  • Still require active treatment or have received a change to their treatment plan within the last 48 hours.