Implementation of a virtual ward as a response to the COVID-19 pandemic.

Objective The aim of this study was to describe and evaluate the implementation of a virtual ward as a COVID-19 hospital avoidance response strategy and identify opportunities for improvement and future applicability. Methods A mixed-method observational study was conducted of a centralised virtual ward, which operated in a large metropolitan Australian health service from 23 March to 1 June 2020. Results In total, 238 unique patients were admitted to the virtual ward, accounting for 264 individual admission episodes and 2451 virtual bed days. Twenty (7.6%) episodes resulted in transfer to hospital and 136 patients provided responses to feedback surveys and reported their experience as very good (61.7%, n=87) or good (34.8%, n=49). Implementation success was high, with the model widely accepted and adopted across the health service. The service delivery model was considered to be low-cost in comparison to inpatient hospital-based care. Conclusions Overall, as a rapidly developed and implemented low-tech model of care, the virtual ward was found to provide an effective, accessible and low-cost solution to managing low-acuity COVID-19-positive patients in the community. This model should be considered in future pandemics as a hospital-avoidance response, with the ability to minimise patient-to-healthcare worker transmission, reduce personal protective equipment use and enhance patient adherence with isolation requirements. Targeted remote telemonitoring should be considered as a future modification to improve patient care. What is known about this topic? Virtual wards aim to reduce hospital demand by providing hospital-level care in community settings such as the patients' home. The COVID-19 pandemic has seen a rapid increase in the utilisation of virtual wards as an acute healthcare response that facilitates contactless care of infectious patients. Despite this rapid adoption, there is limited literature on the effectiveness of virtual ward models of care in a pandemic context. What does this paper add? This study provides a detailed description of the implementation of a virtual ward in a large metropolitan health service. It evaluates the effectiveness of the virtual ward as a COVID-19 response strategy and identifies opportunities for improvement and future applicability. This study contributes to the growing body of literature on the COVID-19 healthcare response and virtual wards. What are the implications for practitioners? This study details the implementation of a virtual ward and highlights potential facilitators and barriers to successful implementation and sustained applicability. Findings provide a comparative benchmark for other health services implementing virtual wards as a pandemic response strategy.