2 Evidence gaps
NICE's guidance identified gaps in the evidence for clinical and cost effectiveness of virtual wards technologies for acute respiratory infections, but the gaps are also relevant to the use of virtual wards in other disease areas. NICE's assessment notes that additional evidence should be collected on the following clinical and cost outcomes:
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Length of virtual ward or hospital stay: this is needed to evaluate the effect of virtual wards on reducing hospital stay lengths and to assess associated resource savings.
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Hospital care escalation and admission rates: this is needed to evaluate the risk of admission to hospital or emergency care during, or after, care on a virtual ward.
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Effectiveness of alerts when using a virtual ward: evidence showing how monitoring alerts are used is needed to evaluate the effectiveness of the overall technology and the associated additional pathway costs and other resource requirements. This should include:
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the types of monitoring alerts raised and how frequently these occur in practice
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what response is needed to investigate the alert and how often this is completed in practice
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how often an alert results in a change in clinical management
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differences in technologies where this affects the number and type of alerts generated.
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Costs and resource use, including virtual ward service delivery costs: data on the cost of virtual ward provision should be collected to model resource requirements of establishing and running virtual wards. Assessment of resource use should consider both costs incurred by the provision of virtual wards and increased costs incurred by the wider healthcare system, including primary care.
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Number of contacts with other healthcare providers: evidence on the frequency of contact with other healthcare providers such as GP visits, home visits and calls to 111 is needed to assess how virtual wards would be expected to affect healthcare demand in other settings and their resource impact on the pathway.
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Demographics and clinical characteristics of those admitted to a virtual ward: this is needed to understand how suitability for virtual wards is defined, and for more robust assessments of impact when comparing people whose care is managed on virtual wards with people having standard care. It would also allow investigations of the effectiveness of, uptake of, and adherence to virtual wards for key population subgroups.
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Patient, carer and healthcare professional experience and acceptability: this information is needed to understand the experience of patients and carers having care on virtual wards, including the acceptability of care and the carer burden, and the experience of healthcare professionals delivering care on virtual wards.