Virtual Wards for Acute Care Patients: A Scoping Review

A scoping review of 22 studies found that technology-enabled virtual wards may offer an alternative to conventional hospital care for selected adults with acute conditions, but the evidence remains largely observational and too heterogeneous to establish comparative effectiveness with confidence. The review included three randomized controlled trials, nine case-control studies, seven cohort studies and three qualitative studies, with substantial variation in virtual-ward models, patient selection and telemonitoring approaches.

Virtual wards in the review combined hospital-level care delivered at home with remote monitoring of vital signs, clinical variables and symptoms. The model could be used to avoid hospital admission after referral from an emergency department or to support early discharge from a hospital ward. Eligible participants were adults presenting to an emergency department or admitted with an acute condition, including infections, gastrointestinal disorders and pulmonary embolisms. Studies focused exclusively on chronic-care exacerbations, trauma, psychiatry, primary care, hospice care and COVID-19 were excluded.

Investigators searched MEDLINE, Embase, Cochrane, CINAHL, Web of Science and PubMed for peer-reviewed publications through 28 February 2025. Searches combined terms for hospital-at-home care, virtual wards, admission avoidance and early discharge with terms for acute disease, telemedicine and remote monitoring. English-, Dutch-, French- and German-language trials, cohort and pilot studies, letters to editors and qualitative studies were eligible, with no minimum sample size required. Two reviewers independently screened and extracted the data, resolving disagreements by consensus or consultation with a third reviewer.

The search identified 8,562 unique records, of which 217 were considered potentially eligible during title-and-abstract screening. Twenty-two studies were retained after full-text review. The research populations included 11,476 patients receiving virtual-ward care, 17,336 receiving hospital care and 134 receiving non-technology-enabled hospital-at-home care. Most studies were published between 2018 and 2025. Average ages in virtual-ward cohorts ranged from 54 to 80 years, and participants were generally older than comparison groups. Infection, particularly pneumonia and urinary tract infection, was the most common indication and accounted for as much as 100% of patients in some studies.

Virtual-ward delivery varied considerably. Most programs combined physician home visits with remote consultations, although some used remote consultations alone. All programs provided daily physician review, often supplemented by nurse visits and additional clinical review when needed. Communication methods included video calls, telephone calls, text, chat, applications and photographs. Care could include medication administration, intravenous fluids, oxygen, nursing and diagnostics. Patients either actively measured and reported information or used automated devices, and some programs combined both approaches. Monitoring ranged from intermittent measurements, including once-daily checks, to continuous transmission of data, with respiratory rate, oxygen saturation, blood pressure, temperature and weight among the most frequently monitored variables.

Escalation during virtual-ward admission was uncommon in most reports, although rates varied. One study reported emergency-service contact in 4% of patients, while unplanned home visits ranged from 3.7% to 19.0%. Most studies reporting transfer to hospital recorded rates between 0% and 6.5%, although one reported 26%. Hospital readmission during the virtual-ward admission ranged from 0% to 2.1%. In one study, intensive-care transfers occurred in 0% of virtual-ward patients and 4% of hospital patients. These observations do not establish equivalent safety because models, populations and reporting differed.

Post-discharge emergency-department visits and readmissions were also examined. Two randomized trials reported nonsignificantly lower 30-day emergency-department visit rates for virtual wards than for hospital care: 11% versus 18% in one trial and 7% versus 13% in another. The trials also reported nonsignificantly lower 30-day readmission rates, at 11% versus 46% and 7% versus 23%, respectively. Results from nonrandomized studies were mixed. Mortality findings varied, but the two randomized trials reported no mortality difference during admission and comparable 30-day mortality between the groups. The review therefore supports cautious interpretation of these outcome measures rather than a conclusion of equivalence.

Twelve studies reported complications or adverse events. Two randomized trials reported lower adverse-event rates in virtual-ward groups, at 0% versus 9% and 9% versus 15%. A third randomized trial reported more adverse events in a remote virtual-ward arm than in an in-home hospital-at-home arm, with a mean of 6.8 versus 3.9 events per 100 patients and a difference of 2.8 per 100 patients, with a 95% confidence interval of −3.3 to 8.9. Findings from case-control and single-arm studies varied, and differences in underlying illness, medication requirements and other reported factors complicated interpretation.

The review’s principal limitation is that it was designed to map evidence rather than perform a formal assessment of effect size or risk of bias. Only three small randomized trials were included, all conducted at the same study centre, and two additional studies drew participants from those trials, reducing dataset independence. Programs generally selected clinically stable patients and were conducted mainly in well-resourced academic hospitals, limiting generalizability to other settings and higher-risk populations. Inconsistent definitions, differing eligibility rules, varied telemonitoring systems and incomplete outcome reporting also restricted comparisons. The authors concluded that virtual wards may be feasible for selected stable patients with acute conditions, but called for robust randomized trials and comprehensive, standardized cost-effectiveness analyses before wider implementation.

Subject of Research: Scoping review of technology-enabled virtual wards for adults receiving acute care

Article Title: Virtual Wards for Acute Care Patients: A Scoping Review

Article References: van Baar de Knegt, S. M. E., Zelis, N., Kaasjager, K. A. H., & Stassen, P. M. (2026). Virtual Wards for Acute Care Patients: A Scoping Review. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10682-2

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10682-2

Keywords: virtual wards, acute care, hospital at home, telemonitoring, remote monitoring, scoping review, adult patients, hospital admission, patient safety, Virtual, Wards, Acute