Virtual Ward for Early Discharge in Patients Receiving Inpatient Care (VIP care)

Virtual Ward for Early Discharge in Patients Receiving Inpatient Care: A Prospective Feasibility Study on Home Monitoring for the Early Discharge of Eligible Hospitalized Patients in an Outpatient Setting

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.

Study Overview

• Status: Recruiting
• Conditions: Telemedicine; Feasibility Studies; Virtual Clinic; Early Discharge; Hospital at Home
• Intervention / Treatment: Combination product: Virtual Ward

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 Type: Interventional
• Enrollment (Estimated): 306
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Michael C. van Herwerden, MD; Phone Number: +31107040704; Email: m.vanherwerden@erasmusmc.nl
• Study Contact Backup: Name: Cox van de Weg, MD, PhD

Study Locations

• Netherlands
  • Rotterdam, Netherlands
    • Recruiting
    • Erasmus Medical Center
    • Contact: Michael van Herwerden, MD; Phone Number: 010 704 0704; Email: m.vanherwerden@erasmusmc.nl
    • Contact: Cox van de Weg, MD, PhD; Email: m.vanherwerden@erasmusmc.nl

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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 Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual Ward arm; Patients receive hospital-level care at home via a Virtual Ward, including remote monitoring of vital signs, digital anamnesis questionnaires, and standard diagnostics and treatment, supported by telemonitoring staff and hospital physicians.	Combination product: Virtual Ward; Hospital-level care at home using remote vital sign monitoring, digital anamnesis via the Digizorg app, and integration with the Electronic Medical Record (HiX), managed by Virtual Ward staff following predefined care pathways.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Successfully Transferred to the Virtual Ward After Providing Informed Consent	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%.	From enrollment to transfer to Virtual Ward (during hospitalization, up to 7 days)

Secondary Outcome Measures

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

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frailty Status Based on Clinical Frailty Scale and PRISMA-7 Questionnaire	Clinical Frailty Scale: 1 (very fit) to 9 (terminally ill); PRISMA-7 score: ≥3 indicates frailty risk.	At enrollment (baseline)
Patient-Reported Experience of Virtual Ward Care	Semi-structured interview assessing experiences, barriers, and facilitators, based on CFIR.	Within 30 days after Virtual Ward discharge
Healthcare Provider-Reported Experience of Virtual Ward Care	Semi-structured interview assessing experiences using CFIR domains and NoMAD questionnaire.	Approximately 6-12 months after study initiation

Collaborators and Investigators

• Sponsor: Erasmus Medical Center
• Investigators: Principal Investigator: Cox van de Weg, MD, PhD, Erasmus Medical Center

Study record dates

Study Major Dates

• Study Start (Actual): April 16, 2025
• Primary Completion (Estimated): October 16, 2028
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: April 13, 2025
• First Submitted That Met QC Criteria: April 13, 2025
• First Posted (Actual): April 20, 2025

Study Record Updates

• Last Update Posted (Actual): February 17, 2026
• Last Update Submitted That Met QC Criteria: February 15, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: telemedicine; hospital at home; telemonitoring; early discharge; feasability; virtual clinic; virtual ward
• Other Study ID Numbers: MEC-2024-0060

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No