The National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK.
Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK.
Age Ageing. 2024 Mar 1;53(3). doi: 10.1093/ageing/afae039.
Virtual wards (VWs) deliver multidisciplinary care at home to people with frailty who are at high risk of a crisis or in crisis, aiming to mitigate the risk of acute hospital admission. Different VW models exist, and evidence of effectiveness is inconsistent.
We conducted a rapid realist review to identify different VW models and to develop explanations for how and why VWs could deliver effective frailty management.
We searched published and grey literature to identify evidence on multidisciplinary VWs. Information on how and why VWs might 'work' was extracted and synthesised into context-mechanism-outcome configurations with input from clinicians and patient/public contributors.
We included 17 peer-reviewed and 11 grey literature documents. VWs could be short-term and acute (1-21 days), or longer-term and preventative (typically 3-7 months). 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.
Insights gained from this review could inform implementation or evaluation of VWs for frailty. A combination of acute and longer-term VWs may be needed within a whole system approach. Proactive care is recommended to avoid frailty-related crises.
虚拟病房（VW）为有虚弱风险的高危人群在家中提供多学科护理，以避免出现危机或应对危机，旨在降低急性住院的风险。不同的 VW 模式存在，有效性证据不一致。
我们进行了快速现实主义综述，以确定不同的 VW 模式，并对 VW 如何以及为何能够提供有效的虚弱管理进行解释。
我们搜索了已发表和灰色文献，以确定关于多学科 VW 的证据。从临床医生和患者/公众贡献者那里获得输入，提取有关 VW 如何以及为何可能“发挥作用”的信息，并将其综合为情境-机制-结果配置。
我们纳入了 17 篇同行评议文献和 11 篇灰色文献。VW 可以是短期和急性（1-21 天），也可以是长期和预防性（通常 3-7 个月）。有效的 VW 运作需要共同的标准协议、信息共享流程、适当的多学科团队，该团队可以远程规划患者护理，并进行良好的协调。VW 可以通过适当选择患者、包括药物审查在内的全面评估、综合病例管理和主动护理来提供虚弱干预措施。患者和护理人员的重要组成部分是与 VW 的良好沟通、他们在家中护理的体验，以及感到参与、安全和有能力管理自己的病情。
从本次综述中获得的见解可以为 VW 用于虚弱管理的实施或评估提供信息。可能需要在整个系统方法中结合使用急性和长期 VW。建议进行主动护理以避免与虚弱相关的危机。
