Virtual Ward for Early Discharge in Patients Receiving Inpatient Care
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Virtual Ward.
- Who it may be relevant to
- Registry conditions: Early Discharge, Telemedicine, Virtual Clinic, Hospital at Home. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- Netherlands
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Virtual Ward for Early Discharge in Patients Receiving Inpatient Care: A Prospective Feasibility Study on Home Monitoring for the Early Discharge of Eligible Hospitalized Patients in an Outpatient Setting
Overview
This study evaluates the feasibility of providing hospital-level care at home for eligible patients through a Virtual Ward. Patients are discharged early from the hospital and monitored remotely using digital vital sign monitoring and anamnesis questionnaires. The primary aim is to determine if at least 30% of eligible patients can be safely and successfully transferred to the Virtual Ward under current Dutch healthcare conditions.
Detailed description
Rationale: Patients undergo extensive diagnostics and treatment adjustments during the early days of their hospitalization, which may become less imperative as their admission progresses. If a patient's vital signs stabilize after the initial hospitalization, and they only necessitate "less urgent" hospital care, an option is to transfer them to the Virtual Ward and thereby creating hospital capacity. This telemedicine-driven model presents an alternative to the conventional in-patient care approach. In the Virtual Ward, patients continue to receive care under supervision of the hospital physician but from the comfort of their own homes. This means the hospital oversees the monitoring of vital signs, performing diagnostics and treatment in the patient's home environment. A growing body of evidence supports the safety of "Virtual Wards." However, although proven safe, its feasibility remains uncertain.
Objective: To assess the feasibility of the Virtual Ward in six pre-defined sub-cohorts of non elective hospitalized patients within the current Dutch healthcare system.
Study design: This is a single-center prospective cohort trial with 6 sub-cohorts.
Study population: Admitted patients (minimum age 18) receiving inpatient care that are eligible for discharge to the Virtual Ward.
Intervention (if applicable): Patients will be discharged to the Virtual Ward with monitoring, diagnostics, and treatment at home.
Main study parameters/endpoints: To assess the feasibility of the Virtual Ward across six pre-defined sub-cohorts of non-elective hospitalized patients by determining the percentage of patients who provide informed consent and are successfully transferred to the Virtual Ward, with a feasibility threshold set at 30% for this pilot phase (adherence). Feasibility is determined per sub-cohort.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Patients who are admitted to the virtual ward can benefit from recovering in a home environment. Potential risks are that they are not within reach of the treating physicians in case of an adverse event. Patients need to fill in questionnaires and measure their own vital signs. There are no additional invasive interventions patients would need to undergo by participating in this study.
Interventions
- Combination product Virtual Ward
Hospital-level care at home using remote vital sign monitoring, digital anamnesis via the Digizorg app, and integration with the Electronic Medical Record (HiX), managed by Virtual Ward staff following predefined care pathways.
Primary outcome measures
- Number of Participants Successfully Transferred to the Virtual Ward After Providing Informed Consent [Time frame: From enrollment to transfer to Virtual Ward (during hospitalization, up to 7 days)]
Secondary outcome measures (10)
- Number of Eligible Patients Invited for Participation [Time frame: From enrollment to invitation during hospitalization (up to 7 days)]
- Number of Invited Patients Providing Informed Consent [Time frame: From enrollment to signing informed consent during hospitalization (up to 7 days)]
- Time from Study Inclusion to Transfer to Virtual Ward [Time frame: From informed consent to Virtual Ward admission (up to 7 days)]
- Number of Notifications Generated During Virtual Ward Monitoring [Time frame: From Virtual Ward admission up to 30 days after discharge]
- Number of Contact Moments with Virtual Ward Staff [Time frame: From Virtual Ward admission up to 30 days after discharge]
- Length of Stay in Hospital Ward Prior to Virtual Ward Transfer [Time frame: From hospital admission to Virtual Ward admission]
- Length of Stay in the Virtual Ward [Time frame: During Virtual Ward stay]
- Hospital Readmission Rate During Virtual Ward Stay [Time frame: During Virtual Ward stay]
- Hospital Readmission Rate Within 30 Days After Virtual Ward Discharge [Time frame: From Virtual Ward discharge up to 30 days]
- Change in Quality of Life as Measured by EQ-5D-3L [Time frame: From baseline (hospital inclusion) to end of Virtual Ward treatment]
Eligibility criteria
Inclusion criteria
- Adult patients (≥18 years old).
- Currently hospitalized and eligible for early discharge according to clinical judgment.
- Ability to provide written informed consent.
- Access to a smartphone or tablet with internet connection.
- Patient is capable of using the Digizorg app or has support from a caregiver who can assist.
- Suitable home situation for Virtual Ward care (e.g., safe environment, necessary utilities available).
- Enrollment in one of the predefined Virtual Ward care pathways
Exclusion criteria
- Patients requiring continuous hospital-based monitoring or interventions that cannot be safely delivered at home.
- Patients who are hemodynamically unstable or require oxygen therapy >5 liters/minute at the time of discharge.
- Patients unable or unwilling to comply with home monitoring procedures.
- Patients with significant cognitive impairment without adequate caregiver support.
- Patients with a life expectancy less than 30 days, as assessed by the treating physician.
- Patients participating in another interventional clinical trial that could interfere with the Virtual Ward protocol.
- Any other condition that, in the opinion of the treating physician, would make participation unsafe or infeasible.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- N/A
- Model
- Single group
- Masking
- Open label
- Primary purpose
- Health services research
Study locations
Netherlands · 1 center
- Erasmus Medical Center — Rotterdam
Publications
- van Herwerden MC, Scholte NTB, Mkrtchjan A, Feyz L, Mol AP, Aitken J, de Boer RA, Chandoesing PP, Gommers DAMPJ, De Haan B, Den Hoed CM, van den Hoogen MWF, Peeters RP, Wlazlo N, Van Der Boon RMA, van De Weg CAM. Delivering hospital care at home in a Dutch Tertiary University Hospital: protocol for a prospective feasibility cohort study evaluating a Virtual Ward for early discharge of inpatients. PMID 41734918
Identifiers
NCT: NCT06936891 · MEC-2024-0060