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Virtual ward and hospital stay compared for length of stay and cost effectiveness

A study published in BMJ Open evaluates the length of stay difference between virtual ward patients and hospital patients along with economic impacts, with key findings including that the use of virtual wards was “clinically effective in terms of survival for patients not needing readmission and allowed for the freeing of three hospital beds per day”; however, the authors raise concerns about the cost of virtual wards, although note the virtual ward in the study was at 24% utilisation.

For the purpose of the study, the research team compared length of stay for hospital-admitted patients and virtual ward patients from a a medium-sized UK hospital, matching patients for analysis by factors including sex, age, primary diagnosis description and clinical frailty score. In order to assess clinical effectiveness, the study also compared survival outcomes and readmission rates to the hospital within six months of discharge.

On length of stay, the study found that overall patients experienced a shorter stay in virtual wards in comparison to matched counterparts in the hospital, with the authors estimating a reduction in hospital stay ranging from 2.1 days to 3.9 days for virtual ward patients. They noted that “a slightly higher percentage” of patients admitted to virtual wards were alive on the six-month follow-up date; however, readmission date within six months after discharge was also higher for patients admitted to virtual wards.

Looking at economic implications, the authors highlight that virtual ward cost was calculated from accrued expenditure whilst cost estimation for hospital bed says “represents the average cost of non-elective care provision in wards on the acute hospital site”, calculated by the finance department within the organisation and using NHS-agreed methodology.  For virtual wards, during the calendar year 2022 the costs for the virtual ward are estimated to be around £1 million for 40 virtual ward beds. With 366 patients admitted to the virtual ward during the study period, these figures suggest that “the cost of saving one inpatient hospital day was £935”, however the cost was calculated based on 24% of the potential usage of the virtual ward.

Discussing their results, for the virtual ward patients who are not readmitted, “care is shown to be non-inferior”, with other studies indicating that “care in virtual wards is preferred by patients and also by the healthcare staff”.

On survival rates, the authors highlight that although patients from the two groups were matched, virtual ward patients “showed a lower frequency of comorbidities, which may have contributed to a larger survival rate on their first admission when compared with hospital patients”. They suggest that this could have led to selection bias towards fitter patients when patients are selected for admission to virtual wards.

Implications for the deployment of large-scale virtual wards are also raised in relation to costs, with the authors stating: “While the virtual ward is shown to be an effective way to reduce hospital stays, it requires more carers and is more expensive than a traditional hospital stay.” In order to be cost-effective, they suggest that virtual ward needs to double throughput; in order to be cost-effective and provide a saving on traditional care, they “need to aspire to triple throughput”.

Ultimately, the authors write, their study concludes that the virtual ward “remains a clinically effective way to care for patients” but potentially “not a cost-effective or efficient way to care for patients”.

Citation: Jalilian ASedda LUnsworth A, et al, Length of stay and economic sustainability of virtual ward care in a medium-sized hospital of the UK: a retrospective longitudinal study

In other news around virtual wards, in January we reported that NHS England awarded a contract with a reported value of £98,237.70 to Health Innovation Network for a review of the London region’s virtual ward and remote monitoring programme.

We also shared an update from Lincolnshire Community Health Services NHS Trust on its virtual ward programme, detailing its approach and some of the benefits.