After spending nearly 12 nights in hospital, Kevina O’Rourke readily admits she was driving her consultant “demented” with questions about when she could go home.
“Mentally, I wasn’t doing great. I got really upset and I just wanted to be at home with my children.”
When she had left Max, then aged 11, and Sadie (6) at home in Rathnew, Co Wicklow, last November, she expected to be away just two or three nights, for the removal of a kidney stone in St Vincent’s University Hospital in Dublin.
But O’Rourke (39) had been warned that surgery to remove the 2.5cm stone, which was encased in a 5cm cyst in her left kidney, was more complex than the norm. The size of the stone and unknown nature of the cyst meant a percutaneous nephrolithotomy procedure was required.
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“This is where they puncture in through my back, puncture straight into the kidney, and they break it all down at source and remove it,” she explains. On Friday, November 7th last, this was completed successfully, under Prof Barry McGuire, within about three hours in theatre.
“It was when they woke me up in recovery, I knew something wasn’t right. I was in fairly extreme pain and I kept saying I feel like something is wrong with my lung.”
An X-ray done in the recovery room showed her left lung had partially collapsed.
Although O’Rourke’s post-op recollections are hazy, she says it took more than four hours for her to be stabilised and the pain brought under control before she could be moved to the urology ward. “I know my blood pressure was extremely low, my heart rate was extremely high, my temperature was spiking and there was just a lot of people around.”
Her lung fully collapsed on the Saturday, causing the left side of her chest cavity to fill with fluid and restrict her breathing. She praises the ward nurses who “did phenomenal work to keep me out of the ICU that weekend”.
The head of ICU visited her at one stage to reassure her they were all prepared if she did deteriorate and that he would be the first face she would see if transferred there. “At that stage, then I just was like, ‘Please, don’t let me die’. It was a very scary weekend.”
A chest drain had to be inserted on the Sunday. “In total, just under four litres of fluid were drained from my chest.”
From the Monday, she began to pick up. “Once I was on the right antibiotics and I had the chest drain, I actually started to recover quite quickly.”
Short walks were possible from the Tuesday, as her strength started to return.
However, a significant bleed and a lot of pain made night 10 in the hospital a bad one. Yet, she was still pushing to be discharged, although she was on intravenous antibiotics and being told she was still too unwell. “I just kept on saying, I promise I’ll recover quicker if you just let me go home.”
Her children had only been able to visit her four times. Two of those visits were kept to 10 minutes, during which “I was trying to pretend I was okay for a short enough period of time for them to see me and leave”, she says. “My six-year-old had never been away from me and she was really distressed every time she came in.”
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Her son was old enough to worry about why he was being told his mother was fine, yet still in hospital.
Coming up to a fortnight there, O’Rourke’s medical team offered her the option of going home on the virtual ward. She would be given equipment to monitor herself three times a day, digitally transmitting results to the virtual ward staff, who would be available to her 24/7. They would liaise with her care team in the urology ward, where she would remain classed as an inpatient and her progress reviewed daily by a consultant.
The concept was new to her, but she jumped at the opportunity to be back with her family.
“I just knew in my heart that I would recover better at home where the kids were. They didn’t have to be near; they just needed to be in the same house as me. And that I’d have my own bed.”
Her one worry was what would happen if she had another bad bleed?
She was given an A4 “patient onboarding” sheet summarising her hospital treatment and advised, if she became unwell, to ring for an ambulance and hand it to the paramedics, who would then know who to contact in transit. This would ensure the urology ward would be ready for her and she would be brought straight back in without having to go through the emergency department.
“That alone was just such a huge comfort to me,” says O’Rourke, who was one of the first surgical patients in Ireland to benefit from a virtual ward. The expansion of St Vincent’s virtual ward to include suitable urology patients is being officially launched this week, to mark World Kidney Day on Thursday, March 12th.
The Dublin 4 hospital was one of two sites, along with University Hospital Limerick, to pioneer the HSE national virtual ward programme, which began in July 2024. Each started with 25 virtual beds and then increased to 40-bed capacity over time.
Since the introduction of virtual wards, 2,540 patients have been safely supported in their home, freeing up more than 23,727 physical bed days for patients who require more traditional care, according to Damien McCallion, HSE chief technology and transformation officer and deputy CEO. “This means that 5,080 patients have benefited; those patients transferred to the virtual ward and those patients utilising the vacated in-hospital bed.”
More hospitals have become involved over the past year, with virtual ward pilot sites now operating in each of the six health regions. These include Our Lady of Lourdes Hospital Drogheda in Co Louth; Midland Regional Hospital Tullamore in Co Offaly; Mercy University Hospital in Cork and St Luke’s General General Hospital Carlow Kilkenny, with Galway University Hospital’s virtual ward admitting its first patient in February.
Patient feedback has been overwhelmingly positive, he adds. “Ninety-eight per cent of patients said they felt safe under virtual ward care and 96 per cent of patients said they prefer the virtual ward to an inpatient hospital stay.”
At St Vincent’s in Dublin, more than 1,300 patients across various medical specialities have been cared for virtually so far, delivering the equivalent of more than 12,400 bed days saved. Now the hospital’s urology department is the first surgical speciality in the country to start using virtual care.
The initial phase, starting last September, has been an enormous success, according to consultant urologist Aisling Looney. She says they have not seen any downsides yet and believes patients feel very supported, particularly as there is “a very clear pathway as to how they can re-enter the hospital system if required. But for us at a consultant level, it’s all about safety.”
Virtual ward patients continue to be under consultant oversight, she points out. Their name remains on the urology ward list and they are reviewed during daily, consultant-led rounds. “We have quite strict and sensible selection criteria as to what patients are suitable.”
That decision is made jointly between consultants and senior nursing staff. “But even if you look at it from overall hospital safety, rather than just the virtual ward patient safety, it also improves the other patients’ access to our clinical environment. We do some of the most complex reconstructive benign and cancer urology surgery in the country, so our level of nursing care on the ward is really very specialist.”
When patients leave the hospital building to be cared for on the virtual ward, “it means that there is a bed on our high-acuity surgical ward to manage other patients. So overall, it’s improving safety and access to specialist care, which is really wonderful for everybody.”
Virtual wards also fit in with enhanced recovery after surgery protocols, which surgical specialities have been using in the hospital for years. “It’s all evidence-based information,” says Looney. “Things like nutrition, sleep, their psychological health and early rehabilitation – and a lot of that is best delivered at home.”
People want to eat their own food; they sleep better in their own bed and they have psychological support from family at home. “What’s really important, of course, is infection prevention. If you decrease a patient’s length of stay physically in the hospital environment, you’re going to decrease their rate of surgical site infection.”
It will also reduce their risk of developing hospital-acquired pneumonia, or contamination with a hospital bug.
A virtual ward patient must be able to take responsibility for their self-care and be capable of communicating any concerns, she adds. They would, preferably, have somebody at home with them too.
Kevina O’Rourke was emotional returning home on November 25th last, coincidentally her husband Shane’s birthday. Over the next few days he continued to get the children up and out to school before work, while her mother moved in to help out.
“I went from the bed to the sofa and the sofa back to bed. And that’s all I was allowed to do because I still had an internal stent.”
She had been given an iPad, a blood pressure monitor, an oxygen monitor and a thermometer to use for online check-ins to the virtual ward, with the first being completed under supervision before she left the hospital. She was rung if any of the readings were untoward. For example, on one occasion, she was asked to measure her blood pressure again because, if it continued to be that low, she would have to go back in.
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O’Rourke, who spent nine days on the virtual ward before being discharged from St Vincent’s, is a “huge fan” of this innovation.
“As a mother, all I wanted was to be at home with my children. It afforded me those nine days that otherwise would have seen me sit in the hospital. As much as I’d like to say, ‘Oh, I would have discharged myself’, I’m not silly, I wouldn’t have. I would have stayed in the hospital for those nine days if they [had] asked me to.”
As it was, Sadie suffered separation anxiety for several months after her mother’s hospitalisation.
“Essentially, I said I’ll be back in two to three days and I disappeared for two weeks. So I was very grateful,” says O’Rourke, “that those two weeks didn’t turn into the guts of four”.
