Diversifying Care Services: Virtual Wards

Image: Steven Gregor

Welcome to our dedicated resources page on virtual wards, an innovative solution for adult social care providers looking to diversify and enhance their services. As the adult social care sector continues to evolve, virtual wards offer a unique opportunity to deliver high-quality, person-centred care remotely, reducing the need for hospital admissions and supporting individuals in the comfort of their own homes.

Explore how this forward-thinking model can transform your service delivery and support the future of adult social care with the resources to follow.

NIHR Evidence webinar: Hospital at home and virtual wards: what works?

An ageing population, with increasing numbers of people living with frailty, is placing growing demands on hospital services. But 1 in 5 hospital admissions could be avoided. Shifting care away from hospitals and into the community is a key government ambition.

Patients, as well as the NHS, benefit from staying out of hospital where possible; a long hospital stay can reduce their independence and trigger a move into long-term supported care.

New service delivery models, enabled by technology, can provide safe alternatives to hospital. They can reduce admissions and speed up discharge. These models, known as hospital at home or virtual wards, vary in how they are led, the staffing model, what conditions they support and for how long. But their common feature is that a multidisciplinary team supports people in their own homes to avoid hospital admission or facilitate an earlier discharge, wherever possible.

In this webinar, researchers will present evidence from 3 reviews (to follow) on hospital at home and virtual wards to help viewers understand:

• What are the key elements of hospital at home and virtual wards?
• What is their impact on outcomes?
• What is their impact on service costs?
• What factors contribute to their success?

Access the webinar recording here.

Access the presentation slides here.

 

Hospital at Home admission avoidance with comprehensive geriatric assessment to maintain living at home for people aged 65 years and over: a RCT

This trial showed the intervention had no difference in living at home at 6 months compared with admission to hospital, while costs were lower across NHS and personal and social services. It concluded that comprehensive geriatric assessment hospital at home can provide a cost-effective alternative to hospitalisation for selected older people.

To read the full study, see here.

 

Admission avoidance at home

Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of older people who have been referred for hospital admission. The intervention probably makes little or no difference to patient health outcomes; may improve satisfaction; probably reduces the likelihood of relocating to residential care; and probably decreases costs.

To read the full study, see here.

 

Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis

Implementing Admission Avoidance and Early Discharge Hospital at Home services requires early development of policies, stakeholder engagement, efficient admission processes, effective communication and a skilled workforce to safely and effectively implement person‐centred Hospital at Home, achieve acceptance by staff who refer patients to these services and ensure sustainability.

To read the full study, see here.

 

A rapid realist review: Virtual wards for people with frailty: what works, for whom, how and why

Effective VW operation requires common standards agreements, information sharing processes, an appropriate multidisciplinary team that plans patient care remotely, and good co-ordination. VWs may enable delivery of frailty interventions through appropriate selection of patients, comprehensive assessment including medication review, integrated case management and proactive care. Important components for patients and caregivers are good communication with the VW, their experience of care at home, and feeling involved, safe and empowered to manage their condition.

To read the full study, see here.

 

Making virtual wards for frailty work better: guide for commissioners

Summary recommendations:

• Aim to implement four building blocks at set-up and operation of the virtual ward – common standards agreements, information sharing inside and outside the virtual ward, appropriate multidisciplinary team (MDT) composition and meetings, good co-ordination in the virtual ward

• Ensure patient and carer involvement and empowerment – communication via a known point of contact, shared decision making, awareness and prevention of carer stress or burnout, and empowered to manage their own care

• Consider how to motivate professionals to work together – for example a ‘team-of-teams’ providing mutual support; trust in shared goals; reciprocal learning through the MDT meetings

• Aim to achieve buy-in of professionals – importance of patient safety and benefit; starting small; taking time to introduce formal agreements and learn new ways of working

• Work with primary care and integrated neighbourhood teams (INTs) on a whole-system approach through population health management: to select patients at high-risk of a crisis as well as those in-crisis, and coordinate their care

• Work with primary care and INTs to ensure effective continuity of care on discharge from the virtual ward in a whole-system approach

• Emphasise the need for proactive and anticipatory care to reduce the risk of future crises as part of a sustainable long-term view of frailty management. Prevention better than cure

• Consider sustainability as frailty increases in an ageing population, alongside possible re-admissions to virtual wards if people with frailty are not stabilised, and the potential benefits of transitioning to the proactive care of those at high risk of a crisis

To read the full policy brief, see here.