P63 Towards effective virtual wards for people with frailty – how, why and for whom

Background Increasing prevalence of people living with frailty is a key challenge to healthcare providers. One solution may be virtual wards (VWs). Our research sought to: examine different frailty VW models; and determine how, why and under what circumstances VWs may work effectively. During our early research, NHS England (NHSE) started roll-out of short-term VWs intended to treat acute patients with frailty crises at home instead of hospital. We expected our work to inform NHSE policy, especially how to ‘do’ VWs better. Methods We conducted a rapid realist review of frailty VWs, searching published and grey literature for evidence on multidisciplinary VWs based in the UK, using a literature-based definition of VWs: the key criterion was a multidisciplinary team (MDT) that makes decisions and plans care remotely. Information (as ‘if-then-because’ statements) on how and why frailty VWs might work was extracted and synthesised iteratively into context-mechanism-outcome configurations (CMOCs). Throughout we engaged closely with clinicians and patient/public contributors. The iterative nature of the realist review led to emerging understanding, encapsulated in a policy briefing, recommendations for practice and implementation activity. Results From 28 documents (2012–2022), we identified two VW models operating in the UK: longer-term, proactive care wards admitting patients at high risk of a frailty crisis; and short-term reactive care wards for people experiencing a frailty crisis (NHSE model). Using evidence from both models, we generated 12 CMOCs, under three themes. First, building blocks for effective VW operation (e.g. common standards agreements, information sharing, appropriate MDT composition, an MDT planning patient care remotely (‘virtual ward rounds’) and a VW co-ordinator. Second, how the VW delivers the frailty pathway (e.g. patient selection, assessment, medication management, proactive care). Third, Patient/Caregiver involvement and empowerment (e.g. communication and feeling safe at home). Mechanisms included motivating professionals (e.g. a ‘team-of-teams’); buy-in; building relationships: professionals, patients and caregivers. Strong emerging themes were: (1) VWs should be integrated into frailty management as a whole, including patient selection into, and discharge from, VWs. (2) For sustainability of VWs, proactive care is needed to prevent frailty crises (alongside as-needed reactive care): ideally, by focussing on proactive care for people at high risk of a frailty crisis – either within the VW or in evolving community ‘hubs’ for frailty management. Conclusion This rapid realist review and its associated policy document have implications for optimal implementation and sustainability of frailty VWs, through proactive care and a whole system approach.

Citation

Westby et al (2025). P63 Towards effective virtual wards for people with frailty–how, why and for whom. Journal of Epidemiology and Community Health. 79:A68. https://doi.org/10.1136/jech-2025-SSMabstracts.140

DOI

10.1136/jech-2025-SSMabstracts.140

URI

https://hdl.handle.net/20.500.14709/1127

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