These wards have the potential to reduce need to build more high-carbon impact hospitals

A virtual ward bed uses 4 times less carbon than a traditional inpatient bed, so helping the NHS achieve its net zero target by 2045, finds the first study of its kind, published in the open access journal BMJ Innovations.

And they are a promising way to care for more patients effectively, with the potential to reduce the need to build more high-carbon impact hospitals, suggest the researchers.

A virtual ward, also known as “hospital at home,” provides hospital-level care to patients in the comfort of their own homes, leveraging digital technology and remote monitoring.

In recent years, particularly in the wake of the COVID-19 pandemic, virtual wards have been widely adopted throughout England to ease pressures on hospital bed capacity and streamline patient flow, say the researchers.

But while existing research has primarily focused on the care outcomes and cost effectiveness of virtual wards, few studies have looked at their environmental impact and carbon footprint.

To plug this knowledge gap, the researchers compared the carbon cost of virtual ward care with that of traditional inpatient care between May 2022 and May 2023 in a large acute hospital trust.

They quantified the avoided carbon emissions for 1260 virtual ward patients, 728 of whom were frail and 532 of whom had an acute respiratory infection.

The researchers used the Greener Care at Home toolkit to calculate the carbon emissions of a care pathway, including carbon activity points, such as accident and emergency (A&E) attendance, travel to hospital in an ambulance/car, and diagnostics.

All inpatient bed days, virtual ward bed days, home energy and community/general practice (GP) call-outs were calculated initially for a random sample of 30 patients, using a manual audit and then for the entire group of 1260 patients, using an internal data collection system.

The researchers used a previously created method to calculate ‘predicted stay’ in hospital for the virtual ward and traditional inpatient care pathways.

The results show that there was a significant difference between the carbon costs of a virtual ward and an inpatient stay, with virtual wards emitting significantly less carbon when evaluated across the entire episode of care.

On average, an inpatient bed emits 4 times more carbon  at 37.9 kg CO₂ than a virtual ward bed day at 8.8 kg CO₂. And avoided carbon emissions added up to 285 tonnes of CO₂ between May 2022 and May 2023.

This doesn’t represent a carbon reduction for the hospital, emphasise the researchers, as hospital beds were still in use by other patients, but it does represent increased capacity.

And the reduced carbon footprint of virtual wards is particularly important as the NHS aims to deliver 40–50 virtual ward beds per 100,000 of the population, say the researchers.

“Having a [virtual ward] in place will not decrease overall carbon emissions for the hospital but enable more patients to be cared for in the most efficient and lowest carbon way possible, enabling the hospital’s capacity to increase and for teams to manage more patients with the same number of inpatient beds,” they write.

Carbon costs were higher, using the manual audit, largely due to the addition of external factors that internal hospital data systems don’t capture, note the researchers.

The researchers acknowledge that they didn’t have any data on carbon emissions from typical home use, and relied instead on government calculations, which estimate average home carbon emissions of 7.4 kg CO₂/day. Nor do patients always fit into a neat box of a mapped pathway, which highlights the complexity of carbon mapping care pathways, they point out.

Nevertheless, they conclude: “[Virtual wards] look like a promising way for hospitals to increase capacity in a model of sustainable healthcare that aligns with the triple bottom line analysis of high-quality care, value for money, and low associated carbon emissions.”

They add: “We know that a traditional inpatient bed is a very high carbon/resource intensive method of treating patients. As our population increases, we will need to create more effective, less resource-intensive ways to treat our local population, without having to build more hospitals as this is extremely high cost, high carbon, and will require additional workforce.”

18/06/2025

Notes for editors
Research: Exploring the carbon impact of virtual wards in a large acute hospital Doi: 10.1136/bmjinnov-2024- 001347
Journal: BMJ Innovations

Funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

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Original research published in BMJ Innovations introduces a pioneering non-invasive device that corrects racial bias in haemoglobin and pulse oximetry measurements. Using green light and a proprietary algorithm to account for skin pigment, the Green Light Oximeter delivers accurate readings across all skin tones and age groups. Designed for use at home, in clinics, and critical care settings, it offers a scalable, accessible solution that could reduce health disparities in oxygen monitoring for ethnic minority patients.Original research published in BMJ Innovations introduces a pioneering non-invasive device that corrects racial bias in haemoglobin and pulse oximetry measurements. Using green light and a proprietary algorithm to account for skin pigment, the Green Light Oximeter delivers accurate readings across all skin tones and age groups. Designed for use at home, in clinics, and critical care settings, it offers a scalable, accessible solution that could reduce health disparities in oxygen monitoring for ethnic minority patients.

In 2022, original research published in BMJ Innovations introduced a pioneering non-invasive device that corrects racial bias in haemoglobin and pulse oximetry measurements. The paper, Innovative technology to eliminate the racial bias in noninvasive, point-of-care (POC) haemoglobin and pulse oximetry measurements, revealed the first ever technology that integrates green light and skin melanin quantification into noninvasive oximetry and haemoglobin measurement. Designed for use at home, in clinics, and critical care settings, it offers a scalable, accessible solution that could reduce health disparities in oxygen monitoring, addressing longstanding inaccuracies in existing devices.

Beyond improving diagnostic accuracy, this technology could potentially drive significant change in health equity, particularly in low-resource and underserved communities. This research is not only advancing science, it is shaping a more equitable future in health technology.

Research with real-world impact

• Health equity: Offers a transformative solution for underserved and low-resource settings, helping reduce racial disparities in diagnostic accuracy
• Global recognition: Accepted for presentation at the UNICEF/SAARC International Conference in Sri Lanka
• Academic endorsement: Attracted direct interest from Cornell University, NYC
• Funding success: Publication supported successful bid for prestigious NIH Phase 2 clinical study grant
• Global collaboration: Catalysed partnerships with leading researchers and institutions, accelerating technology development
• Research visibility: Cited 10 times in two years; six times higher than the field average
  Career progression: Led to mentorship opportunities and a research faculty position for Dr Gokhale
• Award recognition: Winner of the Anaemia Innovation Challenge for its breakthrough in non-invasive haemoglobin measurement

 

“The publication in BMJ Innovations has sparked unprecedented attention and conversation. Key stakeholders like the US Food and Drug Administration, policymakers, and device developers are now taking serious note of this unmet need.”

Dr Sanjay Gokhale
Physician turned bioengineer, and CEO of Shani Biotechnologies

In October 2024, TCU Burnett Medical School in Fort Worth, Texas, hosted an academic event where Dr Gokhale shared the latest updates about his ‘green light oximeter.’ Dr Claudia Perez, the Principal Investigator at the site, joined Dr Gokhale to present a poster to raise awareness as they prepare to launch Phase-2 studies.

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Curbing need for sedation could boost patient safety, cut costs and waiting times, suggest researchers

Giving children a virtual/augmented (mixed) reality playkit to use ahead of an MRI (magnetic resonance imaging) scan seems to ease both their and their parents’ anxieties about this procedure, suggest preliminary findings published in the open access journal BMJ Innovations.

Reducing the need to put a child to sleep, because of the noise and time required to keep still while in the MRI tunnel, could not only boost patient safety, but also cut costs and waiting times, suggest the researchers.

MRI has emerged as an important diagnostic tool in children’s healthcare because of the high quality images produced and lower radiation exposure than CT (computed tomography) scanning, which is particularly important for children with long term conditions, they explain. 

But the procedure can be lengthy, during which time patients must lie still. And it’s very noisy—up to 80 decibels—requiring the use of protective ear defenders, making it a challenging experience for many patients, especially children.

As a result, children are offered a general anaesthetic for the scan. But recent research and safety concerns about the potential impact of anaesthesia on a child’s developing brain have prompted an initiative to reduce the number of MRI scans carried out under sedation.

It is widely accepted that play can reduce children’s anxiety about medical treatment and procedures, and with that in mind, the researchers developed a playkit to help 4–10 year olds have an MRI scan without a general anaesthetic.

They deliberately designed it to require the help of an adult as parental anxiety can directly influence the level of a child.

The playkit consists of a flat-packed cardboard kit for building into a small toy MRI scanner, into which the child can place their toy.

A smartphone slotted into the side of the cardboard MRI scanner enables the child to take on the role of the radiographer, via an augmented reality app. Augmented reality superimposes a computer-generated image on a user’s view of the real world.

The child can then scan their toy with the addition of scanning noises to replicate the MRI experience. Afterwards, the child can swipe through various aspects of the real MRI images the radiographer plans to take.

The kit also includes an age appropriate virtual reality cardboard headset, which, along with the app, allows the child to walk through the hospital virtually, culminating in him/her entering the MRI scanner itself. 

The walkthrough includes four interactive games to prepare the child for various aspects of their journey, such as checking in, being weighed, removing magnetic objects from clothing and staying still for the scan itself. 

The development of the playkit was informed by primary school children’s and parental feedback, and tested on 13 patients and their parents/ carers.

This feedback indicated that the playkit helped some children (and their parents/carers) to prepare for the MRI scan and that it also helped to relieve anxiety during the scan.

The children said that recalling aspects of the playkit during their scan helped them to remain calm and still. Others said that the playkit helped prepare them for what an MRI scanner would look like and the noise that it would make.

Older children seemed to prefer the virtual reality aspects of the kit, while younger children were more drawn to the physical play and augmented reality aspects.

Both children and parents/carers said that they had previously felt anxious about the prospect of an MRI scan because of the unknowns involved. And the children suggested that they would like to have detailed factual information about the MRI scan.

As one child-parent pair found it difficult to build the mini cardboard scanner, the design may need further refinement, and the playkit would need to be tested on much larger numbers of children both nationally and internationally, emphasise the researchers.

But they suggest that the kit has the potential to be adapted for use elsewhere: for example, to help prepare children coming into an admissions unit for planned surgery; during transfer to theatre; and needling procedures.

“The development of the mixed realities MRI playkit addresses a significant global problem within paediatric anaesthesia and presents an opportunity for a change in practice to reduce the number of paediatric [general anaesthesias] and improve efficiency and resource usage within radiology and anaesthetic departments,” they write.

“The longest waiting list in radiology at our hospital  is for MRI scans under [general anaesthesia], and delays in performing scans lead to delays in diagnosis and treatment for children and their families, as well as increased usage of scanning time which further impacts the MRI waiting list,” they elaborate. 

“Additionally, a reduction in the requirement of [general anaesthesia] for paediatric MRI reduces the need for an anaesthetist, enabling their use elsewhere—for example, to help reduce the backlog in elective surgery waiting lists.”

08/11/2023 

Notes for editors
Early stage innovation report: Development and introduction of a mixed realities playkit: decreasing the incidence of general anaesthesia for paediatric MRI doi 10.1136/bmjinnov-2023-001083
Journal: BMJ Innovations

Funding: INNOVATE UK 

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subject: Children

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