Virtual Ward for Early Discharge in Patients Receiving Inpatient Care

Not Applicable

Not yet recruiting

• Conditions: Early Discharge; Telemedicine; Virtual Clinic; Hospital at Home; Feasibility Studies

• Registration Number: NCT06936891
• Lead Sponsor: Erasmus Medical Center

Brief Summary

This study evaluates the feasibility of providing hospital-level care at home for eligible patients through a Virtual Ward. Patients are discharged early from the hospital and monitored remotely using digital vital sign monitoring and anamnesis questionnaires. The primary aim is to determine if at least 30% of eligible patients can be safely and successfully transferred to the Virtual Ward under current Dutch healthcare conditions.

Detailed Description

Rationale: Patients undergo extensive diagnostics and treatment adjustments during the early days of their hospitalization, which may become less imperative as their admission progresses. If a patient's vital signs stabilize after the initial hospitalization, and they only necessitate "less urgent" hospital care, an option is to transfer them to the Virtual Ward and thereby creating hospital capacity. This telemedicine-driven model presents an alternative to the conventional in-patient care approach. In the Virtual Ward, patients continue to receive care under supervision of the hospital physician but from the comfort of their own homes. This means the hospital oversees the monitoring of vital signs, performing diagnostics and treatment in the patient's home environment. A growing body of evidence supports the safety of "Virtual Wards." However, although proven safe, its feasibility remains uncertain.

Objective: To assess the feasibility of the Virtual Ward in six pre-defined sub-cohorts of non elective hospitalized patients within the current Dutch healthcare system.

Study design: This is a single-center prospective cohort trial with 6 sub-cohorts.

Study population: Admitted patients (minimum age 18) receiving inpatient care that are eligible for discharge to the Virtual Ward.

Intervention (if applicable): Patients will be discharged to the Virtual Ward with monitoring, diagnostics, and treatment at home.

Main study parameters/endpoints: To assess the feasibility of the Virtual Ward across six pre-defined sub-cohorts of non-elective hospitalized patients by determining the percentage of patients who provide informed consent and are successfully transferred to the Virtual Ward, with a feasibility threshold set at 30% for this pilot phase (adherence). Feasibility is determined per sub-cohort.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Patients who are admitted to the virtual ward can benefit from recovering in a home environment. Potential risks are that they are not within reach of the treating physicians in case of an adverse event. Patients need to fill in questionnaires and measure their own vital signs. There are no additional invasive interventions patients would need to undergo by participating in this study.

Study Timeline

• Status Verified: 2025-04
• Study First Submitted: 2025-04-13
• Study First Submitted QC: 2025-04-13
• Last Update Submitted: 2025-04-13
• Study Start: 2025-04-16
• Study First Posted: 2025-04-20
• Last Update Posted: 2025-04-20
• Primary Completion: 2025-10-16
• Study Completion: 2025-12-31

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 306

Inclusion Criteria

• Adult patients (≥18 years old).
• Currently hospitalized and eligible for early discharge according to clinical judgment.
• Ability to provide written informed consent.
• Access to a smartphone or tablet with internet connection.
• Patient is capable of using the Digizorg app or has support from a caregiver who can assist.
• Suitable home situation for Virtual Ward care (e.g., safe environment, necessary utilities available).
• Enrollment in one of the predefined Virtual Ward care pathways

Exclusion Criteria

• Patients requiring continuous hospital-based monitoring or interventions that cannot be safely delivered at home.
• Patients who are hemodynamically unstable or require oxygen therapy >5 liters/minute at the time of discharge.
• Patients unable or unwilling to comply with home monitoring procedures.
• Patients with significant cognitive impairment without adequate caregiver support.
• Patients with a life expectancy less than 30 days, as assessed by the treating physician.
• Patients participating in another interventional clinical trial that could interfere with the Virtual Ward protocol.
• Any other condition that, in the opinion of the treating physician, would make participation unsafe or infeasible.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Primary Outcome Measures

Name	Time	Method
Number of Participants Successfully Transferred to the Virtual Ward After Providing Informed Consent	From enrollment to transfer to Virtual Ward (during hospitalization, up to 7 days)	Successful transfer is defined as discharge from hospital to the Virtual Ward with start of home monitoring according to care pathways. Threshold for feasibility is ≥30%.

Secondary Outcome Measures

Name	Time	Method
Number of Eligible Patients Invited for Participation	From enrollment to invitation during hospitalization (up to 7 days)	Eligible patients are those meeting the inclusion criteria, identified during hospitalization.
Time from Study Inclusion to Transfer to Virtual Ward	From informed consent to Virtual Ward admission (up to 7 days)	Time is measured in days between signing informed consent and actual discharge to Virtual Ward.
Length of Stay in the Virtual Ward	During Virtual Ward stay	Measured in days from Virtual Ward admission to discharge from Virtual Ward.
Number of Invited Patients Providing Informed Consent	From enrollment to signing informed consent during hospitalization (up to 7 days)	Informed consent is obtained after providing oral and written information.
Number of Contact Moments with Virtual Ward Staff	From Virtual Ward admission up to 30 days after discharge	Contact moments include staff-initiated, patient-initiated, and home nurse-initiated contacts recorded with reasons.
Hospital Readmission Rate Within 30 Days After Virtual Ward Discharge	From Virtual Ward discharge up to 30 days	Readmission defined as hospitalization for clinical reasons after Virtual Ward discharge.
Number of Notifications Generated During Virtual Ward Monitoring	From Virtual Ward admission up to 30 days after discharge	Notifications include vital sign alerts or digital anamnesis alerts, categorized into low-exceeding or high-exceeding limits.
Length of Stay in Hospital Ward Prior to Virtual Ward Transfer	From hospital admission to Virtual Ward admission	Measured in days from hospital admission to discharge to the Virtual Ward
Hospital Readmission Rate During Virtual Ward Stay	During Virtual Ward stay	Readmission is defined as return to hospital ward due to clinical deterioration or treatment need.
Change in Quality of Life as Measured by EQ-5D-3L	From baseline (hospital inclusion) to end of Virtual Ward treatment	EQ-5D-3L score ranges from 0 (worst health) to 1 (best health). Difference between baseline and end of Virtual Ward stay will be measured.