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Respiratory virtual ward

Bedford Hospital

About us

We have run an Early Supported discharge service for COPD patients since 2012 but since an extremely successful roll out of a COVID virtual ward during the pandemic which freed up innumerable beds we have continued and expanded our previous model to include up to 30 patients with COPD, ILD, chronic asthma overlap and any patients discharged on a new oxygen prescription with a view to removing it once their acute symptoms have settled.

Meet the team

Respiratory Virtual Ward Team at Bedford Hospital

Respiratory Nursing Team:

  • Fiona Maryan Instone and Carol Whelan (Jobshare Service Managers)
  • Upul Jayawardana Band 7 Team Leader
  • Elaine Gillard, Clare Keech, Fernando Fronda, Charlotte Towell, Emanuela
  • Costa-Taveres, Susanne Evans
  • Ably supported by our admin team Caroline , Jacky and Lisa

Our service

As well as the Virtual Ward, we run weekly nurse-led COPD intervention clinics, pleural clinics, 4 x oxygen clinics and home visits, ARAS (acute respiratory assessment service – admission avoidance) and also review respiratory inpatients.

Luton and Dunstable University Hospital

About us

Acute Respiratory Assessment Service (ARAS) is an admission avoidance service run by the Respiratory Nursing Team and Respiratory Consultants from the L&D Hospital. We accept referrals from GPs, Practice Matrons, Paramedics, Pharmacists and Community Nurses.

We have been running Respiratory Early Supported Discharge since 2012 and the service has developed over the years regarding our criteria and capacity. In December 2023 alone, we had 47 ARAS reviews (that’s 47 patients that would otherwise likely have attended ED) and 38 ESD patients (saved on approximately 76 bed days).

Meet the team

Respiratory Nursing Team (01582 497483):

  • Farida Parkar
  • Lizan Drummond
  • Ian Dove
  • Julie Edmends
  • Harisree Satheeshkumar
  • Rani Jose
  • Clider Raj
  • Barbara Lima-Martins

ARAS team: 07535 977268 and

  • Team lead : David Allen (Lead Respiratory Practitioner) 01582 497483

Our service

Key details

Service hours:

  • Monday-Friday 8am-5pm
    (please note if patients referred after 2pm, they will likely be seen the following day)


  • Luton & Dunstable Hospital: Zone B, Chest clinic

How to refer:

  • Contact the Respiratory Team on 07535 977268

Referral Criteria:

  • Non-responding exacerbations of COPD / ILD / bronchiectasis / asthma


  • Recurrent courses of Abx for a respiratory infection (LRTI / pneumonia) but limited clinical improvement

Exclusion criteria:

  • Acute hypoxia
  • Acute asthma (peak flow < 60% predicted)
  • Frank haemoptysis
  • Other significant co-morbidities that are likely to require admission

How we operate

We run a two-pronged model:

  1. Admission avoidance service (Acute Respiratory Assessment Service / ARAS)
  2. Early Supported Discharge (from the wards / ED / ARAS)


  • This is an urgent admission avoidance service that is run by the Respiratory Team and Respiratory Consultants that is based in the Chest clinic
  • Criteria for referral:
    • Patient with a known underlying lung condition (e.g. COPD / Asthma / Bronchiectasis / ILD) who are already on treatment for an acute exacerbation but not improving


    • Recurrent respiratory infections with limited symptom improvement (no underlying disease)
  • Referrals are received from GPs, Practice Nurses, Paramedics, and Pharmacists. Patients known to the service can also self-refer.
  • Patients are seen same day or next day (Mon-Fri) in the chest clinic with bloods and CXR on arrival, with review from Resp CNS and Resp Consultant
  • Most patients are discharged (although occasionally the odd patient may require inpatient care)


  • Step down from the ward / ED / ARAS
  • Patients referred by ward / ED teams by bleep 484/521/141. Patients are then reviewed by Resp CNS for suitability.
  • We can provide nebulisers/O2/monitoring equipment if needed on discharge
  • Patients followed up at home either face-face or virtual (dependent on clinical need) by Resp CNS until deemed suitable for discharge