4 Implementation considerations
4.1 Funding
The National Institute for Health and Care Research's Health and Social Care Delivery Research programme will be reviewing the evidence gaps that might fall within their remit.
4.2 Implementation considerations
To enable safe and effective implementation of these technologies, the evidence generation study should ensure:
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Interoperability of the virtual ward platform with local health records, so that healthcare professionals have timely access to data from ongoing patient monitoring.
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Healthcare professionals have adequate training in the use of these technologies.
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Clear information and adequate support is provided to patients and their carers.
Key challenges to implementing the collection of sufficient data to inform evaluations include:
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Cost and resource requirements of collecting data and implementing the required standards and definitions.
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Heterogeneity in possible virtual ward models, which may include multiple treatment pathways, step-up and step-down care models and differences in admission criteria. This also includes potential differences in technologies used, for example, whether technologies offer continuous or intermittent monitoring, and what level of adherence is achieved for wearable devices.
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Low levels of occupancy in virtual wards that are yet to fully roll-out or reach their target capacity may mean that conclusions from early operations may not be transferrable to later, more mature operating models and activity levels.
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The development of standardised definitions and guidance for recording virtual ward spells and the relationship to inpatient care. For example, early step-down virtual ward recording differed in whether the inpatient episode ended on transfer to a virtual ward or on discharge back to primary care. Adequate guidance and recording standards would need to be developed and taken up by virtual ward operators.
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The ability to set up and maintain data flows to automate and submit required data, and the compatibility of electronic patient records and other systems used to collect data. Interoperability of clinical informatics systems is important for safe and effective implementation, and subsequent evaluations of outcomes. However, virtual ward providers may need resources and time to set up such data sources.
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Technologies and systems used to facilitate virtual wards should have appropriate licencing and standards.
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Implementation may have an additional burden on clinical staff, for example, the need to have training before implementation, data collection and follow up.
ISBN: 978-1-4731-5435-3