Rapid realist review of virtual wards for people with frailty

Abstract

ABSTRACTBackgroundVirtual wards (VWs) deliver multidisciplinary care at home to people with frailty at high risk of a crisis or in-crisis, aiming to mitigate the risk of hospital admission. Different VWs models exist and evidence of effectiveness is inconsistent.AimWe conducted a rapid realist review to identify different types of VWs, and to develop explanations for how and why VWs could deliver effective frailty management.MethodsWe searched published and grey literature to identify evidence on VWs for frailty, based in Great Britain and Ireland. Information on how and why virtual wards might ‘work’ was extracted and synthesised in two rounds with input from clinicians and patient/public contributors, generating 12 hypothesised context-mechanism-outcome configurations.ResultsWe included 17 published and 11 grey literature documents. VWs could be short-term and acute (1-21 days), or longer-term and preventative (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 their communication with the VW, their experience of care at home, and feeling included, safe and empowered to manage their condition.ConclusionsInsights 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. An emphasis on proactive care is recommended.