# Barriers and facilitators to the use of virtual wards: a systematic review of the qualitative evidence

## TL;DR

This study reviews what helps or hinders the use of virtual wards, which provide hospital-level care at home, from the perspectives of patients, caregivers, and healthcare providers.

## Contribution

The study systematically identifies barriers and facilitators to virtual wards using behavioral change models and stakeholder perspectives.

## Key findings

- Common barriers include lack of language, technical, and medical skills among patients and caregivers.
- Strong leadership and appropriate training are key facilitators for successful virtual ward implementation.
- Healthcare system resources like staffing, equipment, and funding are crucial for virtual wards.

## Abstract

Virtual wards offer an alternative to traditional inpatient care, delivering acute care, monitoring, and treatment at home to prevent hospital admissions or facilitate early discharge. The aim of our qualitative systematic review was to understand the barriers to and facilitators for the successful implementation and sustainability of virtual wards from the perspective of any involved stakeholder, using behavioural change models.

The review protocol was registered on PROSPERO (CRD42024519627). The following databases were searched: Medline, EMBASE, CINAHL, PsycINFO, and Academic Search Complete. A three-stage deductive content analysis, as recommended for applying the COM-B (Capability, Opportunity, and Motivation–Behaviour) model and TDF (Theoretical Domains Framework) to qualitative data, was conducted to categorize and map the barriers and facilitators to virtual wards identified in the included studies, using the TDF domains as a guiding framework.

Searches initially identified 7489 articles. Sixteen studies met the inclusion criteria. Common barriers for patients and family members were a lack of language skills, technical skills, and medical knowledge. Caregivers were also required to take on significant medical responsibilities, while patients had to remain self-motivated. The introduction of appropriate training was seen as a valuable facilitator. Healthcare providers faced numerous technological barriers that had the potential to affect care delivery. Strong leadership was an essential facilitator for effective care coordination in virtual wards. From a healthcare system perspective, the availability of resources — such as staffing, equipment, and funding —along with standardized protocols, is crucial for the successful implementation of virtual wards.

Virtual wards can ease hospital capacity issues and support the delivery of safe and effective care in patients’ own homes. However, to realize this potential, we must understand the barriers to, and facilitators of, the use and successful implementation of virtual wards for patients, carers, and healthcare professionals. This understanding will allow targeted strategies and interventions to be developed to support both the delivery and receipt of care on virtual wards.