Acceptance Criteria

Confirmed Diagnosis of Asthma - Patient must have a confirmed diagnosis of asthma by the referring Consultant 

Diagnostics and medications: Required diagnostics are requested by the referring Consultant and acute medications prescribed e.g. Steroids 

Moderate Asthma Exacerbation - The patient is experiencing a moderate exacerbation that requires close monitoring and treatment adjustment but does not require high-dependancy hospital care or intensive hospital care. PEFR more than 50–75% best or predicted and normal speech, with no features of acute severe or life-threatening asthma. 

Stable Clinical Condition: The patient should be clinically stable, with vital signs within acceptable ranges, and not requiring immediate high dependancy hospital care or intensive hospital care. This means: 

• Oxygen saturation (SpO2) at rest of more than or equal to 92% if non-CO2 retainer, and more than or equal to 88% if a CO2 retainer. 

• Respiratory rate is stable and within an acceptable range. 

• No signs of severe respiratory distress or failure. 

• Blood pressure and heart rate are stable. 

• NEWS2 less than or equal to 2 

• Peak flow > 50% of predicted best score 

 Stabilisation Post-Initial Treatment - The patient has been stabilised following initial treatment (e.g., in an emergency department or Inpatient setting) and is safe to be managed in a non-hospital setting with remote support. Note – if the patient needed more than 3-4 nebulisers before stabilising, required intravenous Magnesium or Aminophylline as initial treatment, or presented with a PEFR of less than 33% of predicted these patients can be taken at the discretion of the Consultant after 24 hours of observation in the inpatient setting. 

Ability to Engage with Virtual Care: The patient must be able to engage with virtual care services, which may include: 

• Ability to use technology for remote monitoring (e.g., smartphone, tablet). 

• Capability to measure and report vital signs at home (e.g. using a pulse oximeter).

Capacity for Self-Management - The patient or their caregiver has the cognitive and physical ability to manage the condition at home, including the ability to use inhalers, nebulisers, and peak flow meters. 

Consent and Understanding: The patient (or their caregiver) must provide informed consent to participate in the virtual ward and demonstrate understanding of the care plan and how to seek help if their condition worsens. 

Stable Home Environment - The patient’s home environment is deemed safe and stable, with no significant risks that could compromise their health or the effectiveness of remote monitoring (e.g., availability of heating, absence of significant allergens). 

Adherence to Treatment Plan - The patient has a history of adherence to prescribed asthma treatment and management plans, or there is confidence that they will adhere to the Virtual Ward's care plan. 

Willingness to Participate - The patient (and caregiver, if applicable) is willing to participate in the Virtual Ward pathway and is comfortable with the concept of remote monitoring and management. 

Unstable Vital Signs - Blood pressure, heart rate, respiratory rate, or oxygen saturation levels that indicate instability and require constant monitoring or intervention. NEWS2 score of 3 or more. 

Severe or Life-Threatening Asthma Exacerbation - Patients experiencing a sever or life-threatening asthma attack: 

• Persistent or worsening symptoms despite maximal therapy in an outpatient setting. 

• Requirement for high-flow oxygen, non-invasive ventilation, or mechanical ventilation. 

• Requirement for regular nebulised therapy (more than 2 nebulisers in a 24-hour period) 

Uncontrolled Hypoxemia - Oxygen saturation (SpO2) less than 92% on room air or requiring supplemental oxygen. 

Significant Co-morbidities - Co-existing medical conditions that could complicate asthma management, such as heart failure, COPD, or other respiratory conditions. Recent myocardial infarction or unstable cardiovascular conditions. 

Inability to Self-Manage - Patients who are unable or unwilling to engage in self-monitoring and self-management. Cognitive impairment or lack of support that would prevent effective remote monitoring. 

Recent ICU Admission - Patients who have been recently discharged from the Intensive Care Unit (ICU) following a severe asthma attack may require closer in-person monitoring. 

Poor Adherence to Treatment - History of non-compliance with asthma management plans or medication. Patients with a pattern of frequent emergency department visits due to poor adherence. 

Altered Mental Status - Confusion, delirium, or reduced consciousness that could impact the patient's ability to manage their condition safely at home. 

Mental health issues - Severe/acute mental health issues or substance abuse issues that are significant enough to greatly impact ability to maintain compliance and contact with clinicians. 

Lack of Access to Technology - Patients who do not have reliable access to the necessary technology (e.g., smartphone, internet) or the ability to use it. 

Inability to Self-Manage or Lack of Carer Support - Patients who are unable to manage their care independently or do not have adequate carer support at home. 

Social or Environmental Concerns - Home conditions that are not conducive to safe asthma management (e.g., exposure to allergens, inadequate heating or ventilation), or social concerns that make home care inappropriate. 

Recent Use of Oral Corticosteroids - Patients who have required multiple courses of oral corticosteroids in a short period, indicating uncontrolled asthma. 

End-of-Life Care - Patients requiring palliative care where hospital admission is more appropriate for symptom management. 

Pregnancy with Uncontrolled Asthma - Pregnant patients with poorly controlled asthma may require more specialised care than can be provided virtually.