Virtual Ward for Early Discharge in Patients Receiving Inpatient Care

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

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.

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.

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.