title: The effect of a virtual ward program on emergency services utilization and quality of life in frail elderly patients after discharge: a pilot study.
abstract: BACKGROUND
  Attendance at emergency departments and unplanned hospital readmissions are common for frail older patients after discharge from hospitals. A virtual ward service was piloted to deliver "hospital-at-home" services by community nurses and geriatricians to frail older patients immediately after their discharge from hospital to reduce emergency services utilization.
  
  
  OBJECTIVE
  This study examined the impacts of the virtual ward service on changes in the patients' emergency attendance and medical readmissions, and their quality of life (QOL).
  
  
  METHODS
  A matched-control quasi-experimental study was conducted at four hospitals, with three providing the virtual ward service (intervention) and one providing the usual community nursing care (control). Subjects in the intervention group were those who are at high risk of readmission and who are supported by home carers recruited from the three hospitals providing the virtual ward service. Matched control patients were those recruited from the hospital providing usual care. Outcome measures include emergency attendance and medical readmission in the past 90 days as identified from medical records, and patient-reported QOL as measured by the modified Quality-of-Life Concerns in the End of Life Questionnaire (Chinese version). Wilcoxon signed-rank tests compared the changes in the outcome variables between groups.
  
  
  RESULTS
  A total of 39 patients in each of the two groups were recruited. The virtual ward group showed a greater significant reduction in the number of unplanned emergency hospital readmissions (-1.41±1.23 versus -0.77±1.31; P=0.049) and a significant improvement in their overall QOL (n=18; 0.60±0.56 versus 0.07±0.56; P=0.02), but there was no significant difference in the number of emergency attendances (-1.51±1.25 versus -1.08±1.48; P=0.29).
  
  
  CONCLUSIONS
  The study results support the effectiveness of the virtual ward service in reducing unplanned emergency medical readmissions and in improving the QOL in frail older patients after discharge.
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Doris Y P
authors: DY
authors: Leung
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Diana Tze-Fan
authors: DT
authors: Lee
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Iris F K
authors: IF
authors: Lee
authors: The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors: Lai-Wah
authors: LW
authors: Lam
authors: Hospital Authority Head Office, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: Susanna W Y
authors: SW
authors: Lee
authors: Kowloon West Cluster, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: May W M
authors: MW
authors: Chan
authors: New Territories West Cluster, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: Yin-Ming
authors: YM
authors: Lam
authors: Kowloon East Cluster, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: Siu-Hung
authors: SH
authors: Leung
authors: United Christian Hospital, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: Pui-Chi
authors: PC
authors: Chiu
authors: Kowloon Hospital, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: Nelly K F
authors: NK
authors: Ho
authors: Tuen Mun Hospital, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: Ming-Fai
authors: MF
authors: Ip
authors: Tuen Mun Hospital, Hong Kong Hospital Authority, Kowloon, Hong Kong.
authors: May M Y
authors: MM
authors: Hui
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011788:Quality of Life; D012959:Socioeconomic Factors
keywords: elderly; emergency attendance; emergency medical readmission; emergency services utilization; quality of life; virtual ward