The Virtual Wards Study

(1) Background

"Virtual wards" (VW) or "Hospital at home" (HAH) services involve delivering hospital-level monitoring and treatment to patients in their own homes as an alternative to hospital admission. This approach gained significant momentum during the COVID-19 pandemic, and since then, has been further developed through policy initiatives in England. Notably, VWs were highlighted as a key ambition in the NHS England 'Delivery Plan for Recovering Urgent and Emergency Care Services' published in January 2023, and the recent 2024 Darzi Report.

According to NHS England's VW Framework, patients in VWs should receive hospital-grade care in their homes, facilitated by a multi-disciplinary team (MDT) comprising clinicians, nurses, and allied health professionals. The MDT is typically led by a consultant-level practitioner, such as a nurse consultant, GP, or medical consultant, who assumes overall clinical responsibility for the patient's care. VW admissions are generally short-term, typically lasting up to 14 days. Depending on the patient's needs, care may be provided in-person or remotely through telehealth services and monitoring technologies.

The primary objectives of VWs are twofold: to prevent unnecessary hospital admissions (step-up care) and to facilitate early discharge from the hospital (step-down care). The NHS England framework allows for flexibility in the implementation of VWs, tailored to local needs. However, this flexibility has led to variation in how these services are structured and delivered across different regions.

(2) Aims and objectives

1. Examine the VW models implemented across SY  Documentation of the different models of VWs in operation, focusing on their delivery method and variation across the region, using document analysis and workshops with healthcare staff. 2. Explore the experiences of staff involved in the implementation and operation of VWs  Capture the perspectives of healthcare professionals working within VWs, identifying the challenges and successes they encounter, using semi-structured interviews. 3. Assess the clinical and cost-related outcomes of VWs  Evaluate the effectiveness of VWs in terms of patient outcomes (e.g. length of stay, readmission) and the associated financial implications, such as potential cost savings, through statistical analysis of routine inpatient and VW patient data. 4. Integration of findings from the different work packages  The findings from steps 1-3 will be combined to provide a comprehensive overview of the challenges, successes, and impact of the VWs that have been implemented across SY.

(3) The team

• Suzanne Mason
• Suzanne Ablard
• Charlotte Cotterill
• Emma Goodwin
• Maxine Kuczawski
• Fiona Sampson
• Jen Lewis
• Tracey Young
• Carl Marincowitz

(4) Funding

The NIHR Applied Research Collaboration Yorkshire and Humber (ARC YH) Urgent Care Theme