Cucurachi Sara, Lydon Sinéad, Moens Laura Louise, Manser Tanja, O'Connor Paul
Department of General Practice, School of Medicine, University of Galway, 1 Distillery Road, Galway, Co. Galway, H91 TK33, Ireland.
Irish Centre for Applied Patient Safety and Simulation, School of Medicine, University of Galway, Newcastle Road, Galway, H91 YR71, Ireland.
Int J Qual Health Care. 2025 Jul 4;37(3). doi: 10.1093/intqhc/mzaf065.
Virtual wards offer an alternative to traditional inpatient care, delivering acute care, monitoring, and treatment at home to prevent hospital admissions or facilitate early discharge. The aim of our qualitative systematic review was to understand the barriers to and facilitators for the successful implementation and sustainability of virtual wards from the perspective of any involved stakeholder, using behavioural change models.
The review protocol was registered on PROSPERO (CRD42024519627). The following databases were searched: Medline, EMBASE, CINAHL, PsycINFO, and Academic Search Complete. A three-stage deductive content analysis, as recommended for applying the COM-B (Capability, Opportunity, and Motivation-Behaviour) model and TDF (Theoretical Domains Framework) to qualitative data, was conducted to categorize and map the barriers and facilitators to virtual wards identified in the included studies, using the TDF domains as a guiding framework.
Searches initially identified 7489 articles. Sixteen studies met the inclusion criteria. Common barriers for patients and family members were a lack of language skills, technical skills, and medical knowledge. Caregivers were also required to take on significant medical responsibilities, while patients had to remain self-motivated. The introduction of appropriate training was seen as a valuable facilitator. Healthcare providers faced numerous technological barriers that had the potential to affect care delivery. Strong leadership was an essential facilitator for effective care coordination in virtual wards. From a healthcare system perspective, the availability of resources - such as staffing, equipment, and funding -along with standardized protocols, is crucial for the successful implementation of virtual wards.
Virtual wards can ease hospital capacity issues and support the delivery of safe and effective care in patients' own homes. However, to realize this potential, we must understand the barriers to, and facilitators of, the use and successful implementation of virtual wards for patients, carers, and healthcare professionals. This understanding will allow targeted strategies and interventions to be developed to support both the delivery and receipt of care on virtual wards.
虚拟病房提供了一种替代传统住院治疗的方式，在患者家中提供急性护理、监测和治疗，以防止患者住院或促进早期出院。我们进行定性系统评价的目的是，从任何相关利益相关者的角度，运用行为改变模型，了解虚拟病房成功实施和可持续发展的障碍与促进因素。
该评价方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42024519627）登记。检索了以下数据库：医学期刊数据库（Medline）、荷兰医学文摘数据库（EMBASE）、护理学与健康领域数据库（CINAHL）、心理学文摘数据库（PsycINFO）和学术搜索完整版数据库（Academic Search Complete）。按照将能力-机会-动机行为（COM-B）模型和理论领域框架（TDF）应用于定性数据的建议，进行了三阶段的演绎性内容分析，以使用TDF领域作为指导框架，对纳入研究中确定的虚拟病房的障碍和促进因素进行分类和映射。
初步检索到7489篇文章。16项研究符合纳入标准。患者和家庭成员的常见障碍包括缺乏语言技能、技术技能和医学知识。护理人员还需要承担重大的医疗责任，而患者则必须保持自我激励。引入适当的培训被视为一个有价值的促进因素。医疗保健提供者面临众多可能影响护理提供的技术障碍。强有力的领导是虚拟病房有效护理协调的关键促进因素。从医疗保健系统的角度来看，人员配备、设备和资金等资源的可用性以及标准化协议对于虚拟病房的成功实施至关重要。
虚拟病房可以缓解医院容量问题，并支持在患者家中提供安全有效的护理。然而，要实现这一潜力，我们必须了解患者、护理人员和医疗保健专业人员使用虚拟病房以及成功实施虚拟病房的障碍和促进因素。这种理解将有助于制定有针对性的策略和干预措施，以支持虚拟病房的护理提供和接受。
