1 Recommendations

1.1 Virtual ward platform technologies can be used in the NHS while more evidence is generated to monitor people over 16 with acute respiratory infection in their usual place of residence. They can be used for people who have been:

  • referred for hospital admission or

  • admitted to hospital and their condition is stable or improving but needs ongoing monitoring.

    These technologies can only be used once they have appropriate regulatory approval, including CE mark, and Digital Technology Assessment Criteria (DTAC) approval.

1.2 Virtual ward platform technologies should have these key features:

  • interoperability with electronic patient record systems and associated medical devices

  • appropriate regulatory approval for associated medical devices (devices must also meet local testing standards and be validated for use in a place of residence)

  • validated accuracy in people with black or brown skin for devices that measure oxygen saturation

  • risk-stratified alerts (for example, red, amber or green) for healthcare professionals for when readings go outside of the agreed range (alerts can be based on device-measured vital signs or questionnaire responses)

  • trend-based alerts (to increase specificity) if they are using continuous-monitoring wearable devices

  • patient interface with an easy to use, user-centred design.

1.3 Further evidence should be generated on the following key clinical and cost outcomes:

  • length of virtual ward or hospital stay

  • hospital admission and readmission rates

  • number of alerts when using a virtual ward (including false-positive and false-negative alerts)

  • costs and resource use (including virtual ward service delivery costs)

  • patient and carer experience and acceptability (including carer burden)

  • demographics of the people admitted to a virtual ward (including information relating to health inequalities)

  • healthcare professional experience and acceptability

  • number of contacts with other healthcare providers, such as GP visits, home visits and calls to 111.

Potential benefits

  • System benefit: virtual wards allow people to be cared for in their home or usual place of residence while also reducing pressure on hospital inpatient care. Virtual ward platform technologies allow this treatment setting to be scaled.

  • Clinical benefit: clinical evidence suggests similar outcomes to hospital inpatient care with high reported levels of patient and healthcare professional acceptability. Limitations of the evidence are discussed in section 3.15.

  • Resources: economic evidence suggests that there is potential for virtual ward platform technologies to be cost saving because people are having their healthcare managed at home or in their usual place of residence instead of in hospital.

Managing risk

  • Clinical review: a clinical assessment of suitability for admission to a virtual ward should be done in person by a healthcare professional. Plans relating to monitoring, escalation of care and discharge must be made on admission to a virtual ward. Any alerts should be followed up by a healthcare professional.

  • Individual choice: some people may choose not to be on a virtual ward or may not feel comfortable using the technology and may prefer treatment in hospital. Everyone has the right to make informed decisions about their care.

  • Equality: some companies can loan a smart device and provide internet access for those who do not have it. They can also provide different accessibility features including devices with large screens and buttons, screen-reading software, translation services and apps in multiple languages. Some devices that measure oxygen saturation (pulse oximetry devices) have been reported to overestimate oxygen saturation levels in people with black or brown skin. So, pulse oximetry devices should be validated for accuracy in people with black and brown skin. Limitations should be recognised for any test and a range of outcome measures should be considered.

  • Costs: results from the early economic analysis suggest that the technologies could be cost saving based on current prices and evidence. But, the model uses a number of assumptions and is based on limited clinical evidence. This should be taken into account when negotiating the licence costs.

The evidence generation plan gives further information on the prioritised evidence gaps and outcomes, ongoing studies and potential real-world data sources. It includes how the evidence gaps could be resolved through real-world evidence studies.

  • National Institute for Health and Care Excellence (NICE)