Litchfield Ian, Lewis Richard, Delanerolle Gayathri, Melyda Melyda, Harper Lorraine
Department of Applied Health Sciences, University of Birmingham, Birmingham, United Kingdom.
Birmingham Health Partners, University of Birmingham, Birmingham, United Kingdom.
J Med Internet Res. 2025 Jun 19;27:e75406. doi: 10.2196/75406.
The National Health Service (NHS) in England is facing unprecedented demand for hospital services, with virtual wards (VW) being a central tenet of the strategy to manage these ongoing pressures on capacity. VWs combine digital and analog tools, monitoring systems, and teams of multidisciplinary care providers to support patients in their place of residence who might otherwise be cared for in a hospital. Despite virtual ward programs continuing to proliferate in the United Kingdom and across the globe, the models of care that support them are still evolving, and best practices in their design and implementation are yet to be fully established. It is therefore necessary to continue to gather evidence about the influences that shape their design and support their successful and sustained introduction.
This study aims to explore the experience of staff involved in designing, developing, and delivering VWs as part of the national program, in order to understand the factors that influence their implementation and sustainability.
Qualitative data were collected through semistructured interviews with staff and senior stakeholders involved in developing, leading, and delivering the virtual ward program within one of the largest integrated care systems in England. Data were analyzed using directed content analysis, informed by the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework.
We interviewed 20 participants from clinical and nonclinical roles, including service transformation leads, program leads, physiotherapists, nurses, and consultants. Using the NASSS framework, we identified several key findings: patient context was as important as clinical criteria in determining referral suitability (Condition). Stand-alone digital monitoring solutions with offline capability improved accessibility (Technology). While benefits to patient rehabilitation and hospital capacity were widely understood, concerns over the lack of evidence remained (Value proposition). Clearer messaging about the nature and benefits of VWs was needed for patients and carers, and staff described challenges with remote care and shared responsibility across settings (Adopters). Pre-existing collaborative arrangements helped but varied by specialty (Organizations). NHS targets and metrics of success were considered unrealistic (Wider system). Finally, participants recommended more coherent regional planning that involved consultation with patients (Embedding over time).
If the United Kingdom's VWs program is expected to move forward, it requires patients, their families, carers, and staff to receive coherent messaging of their responsibilities and benefits. Targeted training and ring-fenced time for staff would help, as would the provision of purposely designed patient-facing technologies. Finally, extended planning and funding cycles are needed to gather robust evidence and refine VWs, ensuring better integration with existing services that incorporate the needs and preferences of patients from various sociocultural backgrounds.
英国国家医疗服务体系（NHS）正面临着前所未有的医院服务需求，虚拟病房（VW）是应对这些持续的容量压力战略的核心宗旨。虚拟病房结合了数字和模拟工具、监测系统以及多学科护理提供者团队，以支持那些原本可能在医院接受护理的居家患者。尽管虚拟病房项目在英国乃至全球不断增加，但支持它们的护理模式仍在不断发展，其设计和实施的最佳实践尚未完全确立。因此，有必要继续收集有关影响其设计并支持其成功持续引入的因素的证据。
本研究旨在探索参与设计、开发和提供作为国家项目一部分的虚拟病房的工作人员的经验，以了解影响其实施和可持续性的因素。
通过对参与英格兰最大的综合医疗系统之一的虚拟病房项目开发、领导和实施的工作人员及高级利益相关者进行半结构化访谈收集定性数据。使用由非采用、放弃、扩大规模、传播和可持续性（NASSS）框架指导的定向内容分析法对数据进行分析。
我们采访了20名来自临床和非临床岗位的参与者，包括服务转型负责人、项目负责人、物理治疗师、护士和顾问。使用NASSS框架，我们确定了几个关键发现：在确定转诊适宜性（条件）时，患者情况与临床标准同样重要。具有离线功能的独立数字监测解决方案提高了可及性（技术）。虽然患者康复和医院容量方面的益处已得到广泛理解，但对缺乏证据的担忧仍然存在（价值主张）。需要向患者和护理人员更清晰地传达虚拟病房的性质和益处，工作人员描述了远程护理和跨机构分担责任方面的挑战（采用者）。先前存在的合作安排有帮助，但因专业而异（组织）。NHS的目标和成功指标被认为不切实际（更广泛的系统）。最后，参与者建议进行更连贯的区域规划，包括与患者协商（随着时间推移进行嵌入）。
如果英国的虚拟病房项目要向前推进，就需要患者、其家人、护理人员和工作人员收到关于其责任和益处的连贯信息。为工作人员提供有针对性的培训和专门安排的时间会有所帮助，提供专门设计的面向患者的技术也会如此。最后，需要延长规划和资金周期以收集有力证据并完善虚拟病房，确保更好地与纳入来自各种社会文化背景患者的需求和偏好的现有服务相结合。
