The article on Virtual Wards resonated with me, because in paediatrics we have been doing this for over 25 years. (1) Much of our Paediatric practice could map nicely to adult care, and the untrue adage that children are little adults is totally untrue but the reverse, adults being big children, medically speaking, holds more truth.

So Ambulatory Pediatrics (a version of Hospital at home and virtual ward) is a concept described by Meates et al in 1997. (2) It holds the tenant of keeping children at home as the core principle and in many situations once children on the ward are getting better, they can continue to improve at home. Or their clinical condition allows them to be kept out of hospital and stay at home. A check-in phone call or community nurse visit can support the family, and feeds into the adage that there is ‘no place like home‘. Crucial to this are the ‘ruby slippers’ such as once daily intravenous antibiotic regimens (Ceftriaxone commonly) which enable on going treatment while remaining at home. High dose inhaled bronchodilator via spacer as opposed to nebulisers have also enabled ambulatory practice to embed in paediatrics.

I don’t think commissioning and formal IT arrangements have always supported the process but it is true to say that often there are more children being managed on an ambulatory basis at home, or coming up for a daily intravenous treatment, than there are in the Ward, often being managed by the acute teams on top of their inpatient workload. Obviously our patient population have able carers to look after them which helps, but those adults who can be managed at home should be. It is interesting it has taken a pandemic to try and embed a practice paediatric doctors have been doing for years. Perhaps the Wizard can now be revealed. What else can teams caring for adults learn from paediatrics and the way they look after children?

1. Thornton J. The “virtual wards” supporting patients with covid-19 in the community BMJ 2020; 369 :m2119 doi:10.1136/bmj.m2119

2. Meates M. Ambulatory paediatrics--making a difference. Arch Dis Child. 1997 May;76(5):468-73; discussion 473-6. doi: 10.1136/adc.76.5.468. PMID: 9196371; PMCID: PMC1717173.

Competing interests: No competing interests