Models, designs, and impact of virtual wards: a scoping review
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Tracey Viney1,2,3, Lisa Burrows4,5,6, Tristan Coombe3,5
1Cornwall Partnership NHS Foundation Trust, Bodmin, UK.
Objective:
This scoping review maps international evidence on the models, design features, and reported impacts of virtual wards, addressing technology-enabled approaches that deliver hospital-level care in patients' homes.
Introduction:
Virtual wards expanded rapidly during and after COVID-19, offering hospital-level monitoring and multidisciplinary care at home. Despite their growth, definitions and designs remain inconsistent, and evidence on their impact may vary.
Eligibility Criteria:
This review included studies involving adults (≥18 years) receiving hospital-level care at home through a virtual ward, as well as health care professionals and unpaid carers involved in delivering or supporting such care. Studies exclusively focused on people aged under 18 years were excluded. The concept of interest was virtual wards, defined as health care approaches that remotely monitor patients who would typically require hospital-level care, supported by digital technologies and structured escalation and de-escalation processes. The context encompassed health care delivery outside traditional inpatient hospital settings, where virtual wards were implemented for admission avoidance, early supported discharge, or both. Eligible evidence included English-language primary research studies, systematic and scoping reviews, program evaluations, and relevant gray literature published from 2019 onwards.
Methods:
Two searches were conducted following JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). An initial search (May 2023) and an updated search (January 2024) were run across 6 databases: CINAHL (EBSCOhost), Embase (Ovid), Emcare (Ovid), HMIC (Ovid), MEDLINE (Ovid), PsycINFO (ProQuest). The Health Services Journal (HSJ) was also searched, alongside targeted gray literature sources, including GrayNet, British Library, NHS, and World Health Organization (WHO) websites. Dual screening, piloted data extraction, and narrative mapping with frequency counts were conducted.
Results:
Thirty-one sources (12 from databases, 19 from gray literature) were included. Virtual wards were commonly designed for admission avoidance, early discharge, or both. Most were acute-led, with some joint models; only 1 operated 24/7. Reported features included multidisciplinary input, personalized care plans, escalation protocols, and technologies such as telephone, messaging, video, and wearable monitoring. Documented impacts included improved communication, patient-centered care, cost savings, reduced readmissions, the challenges of digital exclusion, variable discharge criteria, and workforce sustainability. Overall, these findings highlight implications for both patients and health care teams.
Conclusion:
Virtual wards have been presented in the literature as a promising model for implementing digitally enabled hospital-level care at home. To achieve sustainable impact, services require clear admission/discharge criteria, co-design with stakeholders, robust governance, reliable technology, and multidisciplinary workforce planning. Further research is needed to evaluate issues of efficacy, cost, and scalability.
