Key points from the evidence

1. In NHSScotland, a virtual ward is a service delivery model in which patients are monitored at home with minimal face‑to‑face contact with healthcare professionals. It is used as either an alternative to hospital admission or to support earlier discharge. Virtual wards require dedicated and appropriately trained staff. Consultations with healthcare professionals are primarily conducted by telephone or online platforms. A range of virtual ward platform technologies is available to support this model of service delivery. These technologies typically consist of a patient‑facing app or website associated with medical devices for recording symptoms and physiological measures, with a digital interface linking to healthcare professionals.

2. In NHSScotland, ‘hospital at home’ and ‘virtual wards’ are distinct service delivery models. This is different to the wider literature and NHS England where the terms are used interchangeably. In NHSScotland, hospital at home is an established model delivering short‑term, acute‑level hospital care in a patient’s home or a home‑like environment. In contrast, virtual wards are generally less intensive service delivery models, focusing on remote monitoring with escalation of care when clinically required. This SHTG Recommendation is about the virtual ward platform technologies used to support virtual ward models of service delivery.

3. The current evidence base for virtual wards supported by virtual ward platform technologies is limited in both quantity and quality. Although the models described in the literature broadly align with the NHSScotland definition of a virtual ward, no two studies evaluated the same service delivery model. There was considerable variation across studies in virtual ward service design, components, and the type and intensity of monitoring provided. This heterogeneity makes it difficult to attribute outcomes to specific elements of the service model, particularly the contribution of the virtual ward platform technologies themselves. Interpretation of the evidence is further complicated by inconsistent terminology, most notably the interchangeable use of the terms ‘virtual ward’ and ‘hospital at home’.

4. Most of the studies focused on outcomes such as hospital admissions, readmissions, length of stay and mortality. Clear or consistent patient selection criteria are lacking. The studies primarily involved patients with respiratory or other acute conditions, limiting generalisability. While the limited evidence suggests that outcomes for patients managed in virtual wards appear comparable to those for patients managed in hospital wards, the specific added value of virtual ward platform technologies remains unclear. This reflects the fact that studies generally assessed whole models of service delivery, making it difficult to isolate the effects of the platforms from other components of care.

5. A comprehensive systematic review of 69 studies (describing 63 interventions) found low certainty evidence indicating no difference in hospital readmission rates between patients receiving technology-enabled care at home and those receiving inpatient hospital care.¹ Similarly, limited mortality data suggested no difference in survival. The review stated that it remains unclear whether virtual ward platforms offer additional benefits compared with telephone or video conferencing within home-based care models.

6. The National Institute for Health and Care Excellence (NICE) guidance published in 2023 on virtual ward platform technologies for people with acute respiratory infections was based on 19 studies encompassing 6,129 people. Sixteen studies were case series and 17 were on people with COVID-19.²

NICE concluded that there was no significant difference in outcomes (including length of stay, admissions, readmissions and escalation of care) between patients monitored on virtual wards compared with hospital wards. Mortality rates were low and there was no indication of safety concerns. NICE noted that the evidence base was limited by a lack of robust, comparative data from the United Kingdom (UK), and generalisability of the findings was constrained because of study heterogeneity and a predominant focus on people with COVID-19.

7. We identified six additional primary studies published since the NICE guidance and the systematic review (ranging in size from 46 participants to over 3,000).^3-8 Five were observational studies and one was a mixed‑methods evaluation. The studies varied in size and quality and only two included a comparison group. Two studies included a clinically mixed patient population. The participants in the remaining studies were people with acute heart failure, atrial fibrillation, post‑surgical patients or people with COVID‑19. Reported outcomes included hospital readmissions, mortality, length of stay and escalation of care. Although the methodological limitations of these studies mean that firm conclusions cannot be drawn, their findings are broadly consistent with the secondary evidence, suggesting that outcomes for people monitored on virtual wards may be comparable to those for people monitored in hospital wards.

8. NHS Borders piloted a virtual ward for patients with respiratory disease from January to March 2024. The ward supported 50 people over a 10‑week period. Patients were monitored remotely using wearable devices and a clinical dashboard, with daily virtual reviews. Despite some implementation challenges (for example, a reliance of locum staff and limited operating hours), feedback from patients and staff was positive. An estimated 236 hospital bed days were avoided and 84% of patients reported feeling safe and well supported at home.

9. The available economic evidence for virtual wards is limited and firm conclusions on cost effectiveness cannot currently be drawn. Available studies suggest that virtual wards could potentially enable more efficient use of resources, based on patients being discharged sooner from hospital and lower readmission rates, but further data are required to assess costs and benefits robustly.^{2, 4, 9, 10}

10. We used a survey to gather public perceptions of virtual wards in Scotland. The survey was sent to 963 people. Of the 377 respondents, most understood the concept of virtual wards (82%) and felt confident using technology with appropriate support (78%). The majority (65%) were comfortable with home-based monitoring.

If given a choice, 44% of respondents said they would prefer virtual ward monitoring at home versus 25% who would prefer monitoring within hospital, with 31% unsure. Those preferring virtual wards valued being at home with clinical oversight. Those favouring hospital care emphasised safety and immediate access to staff. Respondents who were unsure indicated that their preference would depend on the condition and the reliability of support.

11. From the literature, virtual ward technologies are generally well accepted by patients, with perceived benefits including greater comfort, autonomy and a reduced risk of hospital-associated complications. Virtual ward models of service delivery are not suitable for everyone and individual preferences, home environments and levels of support must be carefully considered. Qualitative evidence highlights the importance of clinician interaction, as well as the need for training and support for patients and their carers to address digital exclusion and reduce anxiety about using remote-monitoring technologies.^{2, 11-14}

12. Virtual ward models of service delivery may risk disproportionately excluding groups such as older adults, people experiencing homelessness, those with low income or disabilities, and individuals with either limited digital access or skills. Additional considerations include cultural or language barriers.^{2, 11-14}

13. There are known limitations of certain monitoring devices, for example pulse oximeters may be less accurate in people with medium to dark skin tones. This underlines the importance of device validation across diverse populations and the use of multiple measures to inform clinical decisions.^{2, 11-14}

14. A 2025 qualitative systematic review identified key factors influencing virtual ward implementation, including the need for skilled remote-working staff, clear protocols, sufficient resources, strong leadership and supportive professional culture.¹¹ The NICE early value assessment highlighted poor interoperability with electronic patient records as a key implementation barrier and similar challenges may be relevant within NHSScotland.^{2, 13}