Impact of remote vital sign monitoring on health outcomes in acute respiratory infection and exacerbation of chronic respiratory conditions: systematic review and meta-analysis

Abstract

BackgroundOur aim was to investigate the effectiveness of virtual wards on health outcomes in patients with acute respiratory infection.MethodsWe searched four electronic databases from January 2000–March 2021 for randomised controlled trials (RCTs). We included studies in people with acute respiratory illness or an acute exacerbation of a chronic respiratory illness, where a patient or carer measured vital signs (oximetry, blood pressure, pulse) for initial diagnosis and/or asynchronous monitoring, in a person living in private housing or a care home. We performed random effects meta-analysis for mortality.ResultsWe reviewed 5834 abstracts, 107 full texts, and judged nine RCTs relevant for inclusion in which sample sizes ranged from 37–389 (total=1627), mean ages between 61 and 77 years, and five judged to be at low risk of bias. Five RCTs had fewer hospital admissions in the intervention (monitoring) group, out of which two studies reported a significant difference. Two studies reported more admissions in the intervention group, with one reporting a significant difference. We were unable to perform a meta-analysis on healthcare utilisation and hospitalisation data due to lack of outcome definition in the primary studies and variable outcome measurements. We judged two studies to be at low risk of bias. The pooled summary risk ratio for mortality was 0.90 (95% CI 0.55 to 1.48).ConclusionThe limited literature for remote monitoring of vital signs in acute respiratory illness provides weak evidence that these interventions have a variable impact on hospitalisations and healthcare utilisation, and may reduce mortality.

Length of stay and economic sustainability of virtual ward care in a medium-sized hospital of the UK: a retrospective longitudinal study

“…Our analysis found the length of stay in hospital prior to virtual ward admission to be shorter than the one in other studies, although many of them were based on COVID-19 virtual wards or other disease-specific virtual wards 5 19 22–24. A common result, however, is a shorter stay in the hospital for virtual ward patients than hospital patients.…”

“…While recent literature reviews found a lower rate of readmission in older patients with COPD 3 and COVID-19 patients 17 after hospitalisation at home and virtual wards, the present study did not find any significant difference, as also reported in Creavin et al . 5 However, readmission rates for all patients (hospital and virtual wards) increased if a patient was from a virtual ward, older and had COPD. The higher rate of readmission is coherent with clinical expectations.…”

“…Our analysis found the length of stay in hospital prior to virtual ward admission to be shorter than the one in other studies, although many of them were based on COVID-19 virtual wards or other disease-specific virtual wards. 5 19 22–24 A common result, however, is a shorter stay in the hospital for virtual ward patients than hospital patients. The present study highlighted that, apart from CKD, the reduction in length of stay is not related to any other primary diagnosis, although it is dependent on the assessed CFS.…”

“…Virtual wards are the response to the chronic and unsustainable high demand for secondary care beds 3. By providing an alternative to continued admission, virtual wards may help bridge the gap between demand and capacity for hospital beds, especially in the context of an ageing population,3 4 although their successes are still debated (see, eg, Creavin and colleagues’ review of randomised controlled trials of virtual wards for acute respiratory infection5). A plan to enrol in virtual wards in most of the integrated care systems in the UK was launched in 2020 with the aim of making available hundreds of thousands of virtual beds (at a cost of hundreds of millions of pounds) in the next few years in order to provide them as an option for every patient 6…”

“…Virtual wards are the response to the chronic and unsustainable high demand for secondary care beds. 3 By providing an alternative to continued admission, virtual wards may help bridge the gap between demand and capacity for hospital beds, especially in the context of an ageing population, 3 4 although their successes are still debated (see, eg, Creavin and colleagues' review of randomised controlled trials of virtual wards for acute respiratory infection 5 ). A plan to enrol in…”