A Hub-and-Spoke Inpatient Model That Preserved Semirural Hospital Access

In 2024, Suroit Hospital, a semirural hospital in Quebec, Canada, faced the imminent loss of 20 acute care beds following a provincial directive limiting the use of private agency nurses. This immediate workforce shortage threatened essential inpatient services for a geographically isolated population, while surrounding urban hospitals lacked the capacity to absorb diverted patients. To prevent closures, the hospital partnered with the Santé Québec West Central Montreal Health and Social Services University Network (SQ-WCMTL) and its Jewish General Hospital University Centre to rapidly deploy a virtual inpatient unit - to the authors' knowledge, the first of its kind in Canada. This Case Study outlines the challenge, design, execution, and outcomes of a two-phase intervention: a 10-day rapid design and mobilization phase culminating in the admission of the first patient, followed by a 5-month hub-and-spoke operating phase. The model enabled Suroit Hospital (part of the Santé Québec-Montérégie West [SQ-MW]) to maintain inpatient capacity without on-site registered nurses. Physicians, licensed practical nurses, and patient care attendants delivered hands-on care locally, while experienced registered nurses - JGHUC employees - provided continuous virtual assessments, medication oversight, and real-time escalation support. Over the first 5 months, the virtual unit generated 786 hospitalization days that would otherwise have been lost. Fourteen patients were admitted in the first 2 weeks, with no transfers to urban hospitals and no adverse safety events. The average length of stay was 9.6 days. Among survey respondents, staff-reported effectiveness in their role was 47% in August 2024 (8 of 17 respondents) and 87.5% in October 2024 (7 of 8 respondents). Comfort with the virtual care technology was reported by 76.5% (13 of 17) in August 2024 and 100% (8 of 8) in October 2024. Patients reported satisfaction, valuing the ability to remain close to home. The rapid implementation surfaced several hurdles, including initial skepticism about safety without on-site registered nurses and communication delays during the first days of operation. Strong executive sponsorship, twice-daily huddles, structured escalation pathways, and agile project management enabled rapid problem-solving and continuous refinement. The initiative demonstrated that virtual nursing models can maintain - and even strengthen - quality and safety when supported by digital readiness, clear governance, and strong interinstitutional trust. After the 5-month operating phase, SQ-MW launched its own virtual ward team, allowing JGHUC to exit the operational model. Although that transition and sustainability phase was not evaluated as a formal study phase, it suggests that the intervention served as a capacity-building pathway toward spoke-site autonomy. This hub-and-spoke approach offers a replicable framework for health systems facing workforce shortages, semirural service disruptions, or inpatient capacity constraints. Likewise, virtual inpatient units can preserve equitable access to care and sustain essential services in communities where conventional staffing models are no longer viable.