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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Virtual Ward arm | Experimental | Patients receive hospital-level care at home via a Virtual Ward, including remote monitoring of vital signs, digital anamnesis questionnaires, and standard diagnostics and treatment, supported by telemonitoring staff and hospital physicians. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Virtual Ward | Combination Product | 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. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants Successfully Transferred to the Virtual Ward After Providing Informed Consent | Successful transfer is defined as discharge from hospital to the Virtual Ward with start of home monitoring according to care pathways. Threshold for feasibility is ≥30%. | From enrollment to transfer to Virtual Ward (during hospitalization, up to 7 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Eligible Patients Invited for Participation | Eligible patients are those meeting the inclusion criteria, identified during hospitalization. | From enrollment to invitation during hospitalization (up to 7 days) |
| Number of Invited Patients Providing Informed Consent |
| Measure | Description | Time Frame |
|---|---|---|
| Frailty Status Based on Clinical Frailty Scale and PRISMA-7 Questionnaire | Clinical Frailty Scale: 1 (very fit) to 9 (terminally ill); PRISMA-7 score: ≥3 indicates frailty risk. | At enrollment (baseline) |
| Patient-Reported Experience of Virtual Ward Care |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Michael C. van Herwerden, MD | Contact | +31107040704 | m.vanherwerden@erasmusmc.nl | |
| Cox van de Weg, MD, PhD | Contact |
| Name | Affiliation | Role |
|---|---|---|
| Cox van de Weg, MD, PhD | Erasmus Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Erasmus Medical Center | Recruiting | Rotterdam | Netherlands |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41734918 | Derived | 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. BMJ Open. 2026 Feb 24;16(2):e115730. doi: 10.1136/bmjopen-2025-115730. |
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In this single-group study, patients eligible for early discharge are enrolled into a Virtual Ward model, providing hospital-level care at home. Care includes diagnostics (e.g., laboratory and urine testing) and treatment (e.g., intravenous antibiotics) equivalent to standard inpatient care, but administered in the home environment.
Vital signs (oxygen saturation, respiratory rate, heart rate, blood pressure, weight, temperature) are monitored remotely three times daily via CE-marked devices and a secure mobile application (Digizorg), connected to the Zorgverlenerscockpit (Electronic Medical Record).
Patients complete digital anamnesis questionnaires three times daily. Alerts for deviating vital signs or symptoms are handled by Virtual Ward staff, who verify measurements and escalate to the responsible physician if needed, according to predefined care pathways.
Communication with patients and physicians follows standard clinical care protocols through (video) calls.
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Informed consent is obtained after providing oral and written information. |
| From enrollment to signing informed consent during hospitalization (up to 7 days) |
| Time from Study Inclusion to Transfer to Virtual Ward | Time is measured in days between signing informed consent and actual discharge to Virtual Ward. | From informed consent to Virtual Ward admission (up to 7 days) |
| Number of Notifications Generated During Virtual Ward Monitoring | Notifications include vital sign alerts or digital anamnesis alerts, categorized into low-exceeding or high-exceeding limits. | From Virtual Ward admission up to 30 days after discharge |
| Number of Contact Moments with Virtual Ward Staff | Contact moments include staff-initiated, patient-initiated, and home nurse-initiated contacts recorded with reasons. | From Virtual Ward admission up to 30 days after discharge |
| Length of Stay in Hospital Ward Prior to Virtual Ward Transfer | Measured in days from hospital admission to discharge to the Virtual Ward | From hospital admission to Virtual Ward admission |
| Length of Stay in the Virtual Ward | Measured in days from Virtual Ward admission to discharge from Virtual Ward. | During Virtual Ward stay |
| Hospital Readmission Rate During Virtual Ward Stay | Readmission is defined as return to hospital ward due to clinical deterioration or treatment need. | During Virtual Ward stay |
| Hospital Readmission Rate Within 30 Days After Virtual Ward Discharge | Readmission defined as hospitalization for clinical reasons after Virtual Ward discharge. | From Virtual Ward discharge up to 30 days |
| Change in Quality of Life as Measured by EQ-5D-3L | EQ-5D-3L score ranges from 0 (worst health) to 1 (best health). Difference between baseline and end of Virtual Ward stay will be measured. | From baseline (hospital inclusion) to end of Virtual Ward treatment |
Semi-structured interview assessing experiences, barriers, and facilitators, based on CFIR.
| Within 30 days after Virtual Ward discharge |
| Healthcare Provider-Reported Experience of Virtual Ward Care | Semi-structured interview assessing experiences using CFIR domains and NoMAD questionnaire. | Approximately 6-12 months after study initiation |