Virtual ward
A virtual ward allows patients to get the care they need at home safely and conveniently, rather than being in hospital.
Just as in hospital, people on a virtual ward are cared for by a multidisciplinary team who can provide a range of tests and treatments. This could include blood tests, prescribing medication or administering fluids through an intravenous drip. Patients are reviewed by the clinical team and the 'ward round' may involve a home visit or take place through video technology. Many virtual wards use technology like apps, wearables and other medical devices enabling clinical staff to easily check in and monitor the person's recovery.
Virtual wards use the systems and staffing of a hospital ward, but without the physical building: they provide preventative care for people in their own homes.
In the developing world a virtual hospital interconnects villages with their main hospitals, and hospitals in the West using Telemedicine. There is a traditional healthcare referral system, where the patient's medical information is collected by e-clinics in rural third world communities using a computer, or mobile phone and sent to a general practitioner based at the virtual hospital. They then either provide a diagnosis or refer the patient to the relevant virtual hospital department where specialist consultants across the world are linked together through the Internet.
The work of virtual hospitals is influenced by reports published by the World Health Organization on Telemedicine developments, American Telemedicine Association and the work of Zaidi, et al. and Denis Gilhooly Principal Adviser in the United Nations.
Telemedicine uses ICTs to overcome geographical barriers and increase access to healthcare services. This is particularly beneficial for rural and underserved communities in developing countries - groups that traditionally suffer from lack of access to healthcare.'
Seha Virtual Hospital
Seha Virtual Hospital in Riyadh has been recognised as the world's biggest virtual hospital by the Guinness Book of Records. Mona Sahman Al-Subaie, the chief executive, says it offers solutions to challenges including "geographical distances, the lack of specialised resources, the high cost of healthcare and trying to improve the experience of the patients". As in other countries it developed during the COVID-19 pandemic. In 2025 it works with 224 traditional hospitals, offering patients access to remote expertise in 44 specialised services, including cardiology, critical care, neurology and psychiatry.[Bupa]
Bupa plans to open a virtual hospital in Madrid, the Blua Sanitas Valdebebas Hospital, in 2025, which it says will bring together "the best of physical and digital healthcare". There will be digital check-ins and virtual consultations with surgeons before admission. Ultrasounds will be carried out at home though the surgery will still happen in the hospital. Patients' recovery will be monitored via digital technology.[Galway]
A virtual hospital has been started on Clare Island which uses AI and remote monitoring to manage chronic diseases such as chronic obstructive pulmonary disease and heart failure for patients who would otherwise have had to take a ferry to the mainland to receive care.Croydon
An early type of virtual ward was developed by many teams across England, for example, in Croydon Primary Care Trust.The Croydon project won in four categories of the 2006 Health Service Journal Awards namely Primary Care Innovation, Patient-Centred Care, Information-Based Decision Making, and Clinical Service Redesign. This was the first time in the 25-year history of the HSJ awards that a project won in four categories. In 2007 it won the Transformation category of the Public Service Awards run by The Guardian and was judged overall winner of those awards.
Key aims
The key aims of virtual wards are to:- Act on evidence-based forecasts from predictive risk modelling in order to reduce non-elective secondary care usage
- Provide multidisciplinary case management
- Serve as a communications hub for all those involved in the care for these complex patients
- Offer intuitive working systems that appeal to patients and clinicians alike
Like a hospital ward, the capacity of the ward is set – usually between 0.5% and 1% of the number of patients grouped together. Also, like a hospital ward, patients are admitted and discharged from those beds. The ward is termed virtual as these beds are not real, and care takes place in the most appropriate setting for the patient, usually at home. Initially, the patients at highest risk of admission to hospital are considered for admission to the ward and for intensive case management. When one of these "beds" becomes vacant as the patient stabilises then the predictive algorithm is looked to for a replacement.
The virtual ward team use enhanced tracking to ensure that they can reduce the likelihood of admission, and should the patient be admitted into secondary care follow their process through hospital and attempt to facilitate an earlier discharge back into the community.
Admission
Admission to a virtual ward is determined both by predictive modelling and by clinical decision making by the virtual ward team and the patient's doctor. This ensures that the patients admitted to a virtual ward are truly those who will benefit the most, i.e. those most at risk of unplanned hospital admission. The NHS in England owns two predictive risk models which were commissioned from a consortium led by The King's Fund. These predictive tools are known as PARR, which was built by New York University and the Combined Model, built by Health Dialog.At the time of admission to the virtual ward, the virtual ward lead, which may be an assertive case manager as in Dudley PCT's collaborative model, or a community matron visits the patient at home and conducts an initial assessment. This record, and all further entries by ward staff, are entered into a community care record, and additionally recorded at the patient's GP practice. A summary from the GP computer system is pasted into these ward notes before the initial assessment, so as to provide background information and avoid unnecessary duplication of work. The GP practice is informed of all significant changes to the patient's management.
Staff
- The day-to-day clinical work of the ward is led by a senior nurse which may be an assertive case manager or a community matron. Other staff include a social worker, health visitor, pharmacist, community nurses and other allied health professionals.
- A key member of staff is the ward administrator. With a dedicated telephone number and email address, the ward administrator is able to collect and disseminate information between patients, their carers, GP practice staff, virtual ward staff, out of hours providers, emergency services, and hospital staff.
- Medical input as obtained as needed by the virtual ward team. In most cases the virtual ward team will meet weekly with the GP practice to discuss patients on their case load. The team is also able to book surgery appointments to see any patient's usual GP.
- The virtual ward develops close working relationships with organisations such as hospices, drug & alcohol service and voluntary sector agencies.
Daily routine
Patients in a "red" bed should be reviewed by the team daily, "amber" beds reviewed at least weekly, and "green" beds reviewed no less than monthly. Any patients that the clinical team decide are no longer in need of regular review should be considered for discharge from the ward.
The virtual ward clerk needs to track these patients in the appropriate level bed, track admissions and discharges, and ensure that up-to-date information is available to be supplied to engaged stakeholders.