WITHDRAWN Does Delivery of Care in Virtual Wards Have Implications for NICE Guidelines?

OBJECTIVES: To scope whether there were potential safety implications of using National Institute for Health and Care Excellence (NICE) guidelines within the newly proposed system of virtual wards, which is going to be implemented by the National Health Service in England to enable patients to receive hospital-level care in their own home.

METHODS: All clinical guidelines published by NICE over the past 5 years were reviewed and data extracted for whether the guidelines made recommendations that could be influenced by their use in virtual wards.

RESULTS: Thirty-three out of 208 guidelines (11%) could be affected by their use in virtual wards. Of these, eleven included recommendations specific for either an inpatient or outpatient setting (e.g., sepsis, nutrition support, diabetic foot). Five guidelines were specific to hospital or community care and may not directly apply to virtual wards (e.g., intravenous fluid therapy in hospital, hospital-acquired pneumonia and community-acquired pneumonia, and prophylaxis of venous thromboembolism in hospital). Seven guidelines mentioned criteria that would warrant hospital admission, which could change if remote monitoring in virtual wards was available (e.g., antenatal care, bronchiolitis in children). Guidelines that covered topics involving an inpatient stay followed by a period of recovery/rehabilitation in the community could be affected by virtual wards (e.g., traumatic injury, acute coronary syndromes, acute heart failure). Some guidelines already recommended delivery of hospital-level care in the community (e.g., hip fracture guidelines, chronic obstructive pulmonary disease, and COVID-19).

CONCLUSIONS: Implementation of virtual wards may have implications for a significant number of NICE guidelines, which may require amendments to account for this new model of care.