Virtual Wards for Acute Care Patients: A Scoping Review

BACKGROUND: Increasing capacity pressures and overcrowding in hospitals and emergency departments (EDs) have led to a global surge in the adoption of technology-enabled hospital-at-home programs, also known as virtual wards (VWs). These models provide hospital-level care in patients' homes supported by remote monitoring, aiming to shorten or avoid hospital admission. While substantial evidence supports the feasibility of VWs for chronic care, evidence for use in patients with acute conditions remains limited. This scoping review aimed to map existing evidence on VWs for acute medical patients within acute care settings. METHODS: In February 2025, multiple databases were searched to identify studies evaluating VWs for adult acute care populations. Outcomes included clinical and safety variables, length of stay, functional outcomes, cost and resource use, barriers and facilitators to implementation, user experiences, and qualitative analyses. RESULTS: Twenty-two studies were included (RCTs n = 3, case-controls n = 9, cohort n = 7, qualitative n = 3), with substantial heterogeneity in VW models and telemonitoring approaches. The most common indication was infection (e.g. pneumonia, urinary tract). Results of this narrative synthesis suggest care delivered in VWs may be similar to hospital care for rates of ED visits, readmission, short-term mortality, and adverse events. Length of stay in the hospital tended to be shorter. Functional outcomes may be better in VWs. Cost analyses were limited and showed mixed results. Surveys and qualitative analyses indicated high acceptability and generally positive experiences among patients, carers, and healthcare staff. DISCUSSION: Evidence from the predominantly non-randomized studies included in this review suggests that VWs may be a feasible alternative for selected acute care patients, with outcomes broadly similar to standard hospital care. Substantial heterogeneity in study designs, alongside the descriptive nature of this synthesis, limits the evaluation of evidence strength and comparability. Robust randomized trials and comprehensive cost-effectiveness analyses are needed.