Evolution of a Large-Scale Virtual Nursing Program: Utilization, Geographic Reach, and Cost Comparison at a Tertiary Care Center in Saudi Arabia, November 2021–July 2025

Background/Objectives: Virtual nursing is a component of digital healthcare delivery, but evidence describing the long-term development, geographic expansion, operational performance, and economic implications is limited. This study evaluated evolution of the Virtual Nursing Program at King Faisal Specialist Hospital & Research Centre (KFSH&RC) from November 2021 to July 2025. Methods: A retrospective observational program evaluation was conducted using data from November 2021 to July 2025. Data included patient characteristics, geographic distribution, consultation volume and modality, clinical-group activity, no-show rates, and comparative costs of virtual and physical clinic encounters. Annual unique-patient counts described patient reach, whereas patients seen reflected service utilization and activity volume and could include multiple visits or appointments by the same patient. Results: Patients Seen increased from 662 in November–December 2021 to 15,323 in 2022, 32,630 in 2023, and 51,008 in 2024, reaching 38,471 during January–July 2025. The observed calendar-year number of unique patients was 786 during November–December 2021, 9741 in 2022, 6135 in 2023, 13,792 in 2024, and 15,672 during January–July 2025. Geographic reach expanded, with the proportion of patients from the Central Region decreasing from 99.2% to 60.5%. Also, 89,245 consultations were recorded, of which 89,185 (99.9%) were telephone-based. Medical Nursing (30,330), Surgery–Perioperative (21,051), and Cancer Center of Excellence (11,739) had the highest cumulative appointment volumes. In the comparative cost dataset, 46,345 virtual and 331,710 physical encounters were recorded, with mean costs per visit of 625.61 and 934.48 Saudi riyals, respectively, representing a 33.1% lower observed mean cost per virtual encounter. Conclusions: We demonstrated expansion in patient reach, geographic coverage, and service diversification during the November 2021–July 2025 evaluation period, while virtual encounters were associated with lower observed costs across all evaluated service lines. Future prospective and comparative studies should evaluate clinical outcomes, patient experience, and full cost-effectiveness.