Healthcare systems worldwide strive to improve patient outcomes while keeping costs under control in the face of a growing ageing population. To tackle this challenge, “virtual wards” are gaining traction, providing patients the opportunity to receive comprehensive, hospital-level acute care from the comfort and familiarity of their own homes.
Accelerated by the COVID-19 pandemic, virtual wards allow patients to receive the same multidisciplinary care provided by hospitals, whilst shielding frail and vulnerable patients from hospital-acquired infections. By using innovative medical devices, clinicians can now bring advanced diagnostics, monitoring and therapies, previously restricted to the hospital setting, into patients’ homes. Patients can join the virtual ward in two ways: by early discharge (step-down) from the hospital, or by avoiding admission altogether (step-up).
As virtual wards are rolled out across the world, evidence supporting their implementation is growing. They can provide a better patient experience and improved outcomes, and whilst not the primary goal, create additional hospital capacity. Through increased patient choice and personalisation of care, home treatment can often lead to higher patient satisfaction, as well as lowered mortality and readmission rates compared to inpatient care. Home-based hospital-like care also protects patients from infections and complications, such as delirium, associated with prolonged hospital stays, as well as reducing psychological stress and disruption, especially for elderly and vulnerable patients.
Although virtual wards operate remotely, their cost-effectiveness is largely measured on staffing expenses. By enabling early discharge and preventing unnecessary hospital admissions, the programs also help to optimise resource allocation and reduce overall healthcare expenditure. Alongside the virtual ward approach, a Dutch study estimated an annual saving of €86 per patient enabled by Point of Care (PoC) renal function tests in community pharmacies, demonstrating the potential cost benefits when taking some treatments out of a traditional hospital setting.
Like any new initiative, widespread implementation of virtual wards brings to light a number of challenges, particularly when trying to establish the level of care matching that of a hospital in-patient. Accurate and frequent patient monitoring is essential to support clinical decision-making. Early detection of any deterioration in patients’ conditions enables timely in-person medical intervention while accommodating for clinician travel time to the patient. Furthermore, secure and user-friendly systems must be in place to handle sensitive information properly and to communicate monitoring results effectively to patients. Ensuring the necessary technology is available to facilitate these processes is crucial for supporting responsive and timely decision-making.
Diagnostics
PoC and self-testing diagnostics are crucial for virtual wards, providing timely information for home patient management. However, the shift towards decentralised and self-administered testing presents a number of challenges. Ensuring usability for non-specialist users, maintaining patient engagement and integrating seamlessly with existing healthcare systems are vital to maximising the impact of these innovations.
Examples of some of the innovations in diagnostics tools are Abbott’s i-STAT, which brought essential blood chemistry and haematology testing to the bedside, gaining traction in emergency departments and intensive care units for its speed and portability. Launched in 2014, LumiraDx’s microfluidic technology advances rapid testing of inflammation markers (CRP) and coagulation metrics (INR, D-Dimer) from a simple finger-prick sample, making it ideal for decentralised care settings like virtual wards and particularly suited for non-specialist users.
While some tests still require a care professional, there are options for self-administration or continuous monitoring. Capillary Blood Glucose (CBG) testing is a prime example of this evolution. In the 1960s, bedside blood sugar testing allowed clinicians to make timely decisions for critically ill diabetic patients. The 1980s saw the commercialisation of self-administered finger-prick tests, which were smaller, cheaper and more accurate. This frequent monitoring empowered patients to manage their glucose levels independently. One of the latest areas seeing a revolution is body-worn Continuous Glucose Monitors (CGM) like Freestyle Libre and Dexcom, providing real-time readings and eliminating the need for routine manual finger-pricks.
Testing technology needs to be distributed to bring it closer to patients, avoiding the time and cost of moving equipment and samples. Near-patient Testing (NPT) is crucial for virtual wards’ cost-effectiveness. For instance, in a virtual respiratory ward, NPT devices can monitor inflammation markers to detect worsening conditions and enable timely interventions. A UK pilot study showed that NPT for inflammation markers reduced follow-up visits and improved safety, saving up to £3,914 per patient.
The evolution of PoC testing reflects a shift from centralised, professional-driven testing to personalised, real-time and non-invasive monitoring. Each phase enhances condition management, patient autonomy and quality of life, with wearable and non-invasive technologies promising to take this journey even further. However, integrating technology into daily life brings an explosion of information and therefore can present challenges. Usability, patient engagement and seamless healthcare system integration must be addressed to maximise these innovations’ impact.
The Lumira point-of-care diagnostics instrument, developed with Team Consulting.
Monitoring
While remote monitoring tracks a wide range of vital signs and features automatic alarms, clinicians can feel less confident in early detection of deterioration compared to in-person assessment. Clinicians inherently use a combination of visual, auditory, tactile and olfactory cues to assess a patient’s condition. Some of these elements are not fully captured by sensors, highlighting an innovation opportunity for intuitive ways to present patient conditions to remote clinicians.
Distributed technologies can now track key vital signs such as temperature, pulse, blood pressure, respiratory rate, oxygen saturation and weight more effectively. Wearables are leading the way and have evolved from bulky devices to minimally invasive ones, allowing near-continuous monitoring. For example, Aktiia’s wrist-based blood pressure monitor offers continuous blood pressure tracking, and advances in ambulatory ECGs and low-power electronics extend monitoring capabilities outside traditional care settings. These advancements provide real-time data, enabling timely interventions and better outcomes.
Monitoring devices should be designed for home use, considering patients as primary users with minimal clinician oversight. Measurements should be recorded automatically or with minimal intervention, and device characteristics like weight, size and power requirements must be tailored to home use.
The Aktiia wearable, connected blood pressure monitor, developed with Team Consulting.
Human factors
Certain patient groups, like the elderly, frail individuals, people with disabilities and those with limited digital skills, are often overrepresented in virtual wards. These groups are particularly vulnerable to usability problems, leading to frustration, confusion and reduced engagement. Such challenges may result in missed medication doses, improper test use and poorer health outcomes, therefore, designing systems with these patients in mind is crucial during any HF testing and product development.
Monitoring provides reassurance to patients with chronic conditions, and in virtual ward settings, patients report high satisfaction due to the sense of security and continuity of care. However, poor information design can negate this benefit. Diagnosing asymptomatic conditions, such as chronic kidney disease, can be difficult for patients to understand, and while they value immediate feedback when collecting their own data, they often lack the expertise to interpret raw numbers effectively. Poorly designed communication can overwhelm patients, leading to anxiety or uncertainty, and textual representations of results can also mislead or frighten patients. Words like “chronic” are often interpreted as “serious,” and terms like “kidney failure” can cause unnecessary alarm, but personalised written explanations or graphical representations, tailored to the user, can provide reassurance and promote patient involvement in their treatment.
Test reliability in PoC testing often depends on minimising use error, meaning patients must follow instructions correctly. A well-designed device is accessible, intuitive and minimises potential use error by addressing the unique needs of vulnerable populations. By improving information design, these systems can realise their full potential while supporting equitable and effective healthcare delivery.
Interoperability and integration
Devices enabling virtual wards can come from different manufacturers, requiring effective system integration. For example, diagnostic results should be recorded in various systems, including electronic patient records, shared care records, picture archiving and communication system (PACS) for imaging results and the local information management system (LIMS) for diagnostic results. However, the interaction with third-party systems can create cybersecurity risks that are difficult to control. Manufacturers thus minimise such connections, which conflicts with the need for collaboration in virtual wards, where multiple providers manage test results and vital signs.
To avoid data silos and guarantee efficient data management, real-time system synchronisation is critical, especially in emergencies. Unlike traditional hospital wards, where a planned team responds to emergencies, virtual ward patients may be attended by emergency ambulance crews, GPs on home visits, community nurses and care assistants. These professionals need access to complete, up-to-date information for the best patient outcomes and seamless virtual ward care.
Advanced cybersecurity solutions are required to ensure all sensitive information is rapidly available to healthcare professionals when needed while keeping it safe from unauthorised access.
Cybersecurity
People are typically the weakest link in cybersecurity, especially among frail and elderly patients on virtual wards. Weak passwords, casual data sharing, lack of cybersecurity awareness, negligence and human error are key concerns. Healthcare professionals on virtual wards should be trained to teach robust cybersecurity habits, but systems should be “Secure by Design” to minimise cybersecurity risks from user actions. Safety features should be user-friendly to avoid users feeling the need to circumvent them. This can only be achieved through co-design involving patients, cybersecurity professionals, IT staff and healthcare professionals, reflecting the shared responsibility for sustainable cybersecurity.
By focusing on these elements, healthcare providers can harness medical devices to deliver safe, effective and patient-centred care at home. Collaboration between clinicians, medical technology developers and policymakers is essential to overcome challenges, scale virtual wards and redefine the future of healthcare delivery.
Virtual wards represent a transformative approach to healthcare delivery, offering hospital-level care in the comfort of patients’ homes. By leveraging advanced diagnostics, monitoring technologies and innovative therapeutic tools, virtual wards improve patient outcomes, enhance satisfaction and reduce healthcare costs. However, their success hinges on several critical factors, including seamless system integration, real-time data synchronisation and robust cybersecurity measures. Addressing the human-element, particularly for vulnerable patient groups, is equally vital to ensure accessibility, usability and patient engagement. Collaboration among clinicians, engineers and managers is essential to overcome challenges, refine practices and unlock the full potential of virtual wards. By maintaining a patient-centred approach and embracing technological innovation, healthcare systems worldwide can redefine care delivery and meet the growing demands of more hospital acute care.
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