Journal Article

Effect of a postdischarge virtual ward on readmission or death for high-risk patients: a randomized clinical trial.

Dhalla IA; O'Brien T; Morra D; Thorpe KE; Wong BM; Mehta R; Frost DW; Abrams H; Ko F; Van Rooyen P; Bell CM; Gruneir A; Lewis GH; Daub S; Anderson GM; Hawker GA; Rochon PA; Laupacis A.

Preventing hospital readmissions has been a major health system priority for several years. Although recent data indicates that readmissions in adult patients are decreasing slightly, the approaches individual hospitals or health systems should use to prevent readmissions remain unclear. This randomized controlled trial evaluated the effect of a postdischarge virtual ward where patients received postdischarge care from a multidisciplinary team that met daily to review the patient's progress, conduct home visits, arrange home services, and coordinate care with the patient's primary physicians. Patients were admitted to the virtual ward for a mean of 35 days after discharge and received 3 home visits on average during that time. Despite the intensity of the intervention, there was no effect on 30-day readmissions or any other clinical outcome compared to usual postdischarge care. Another recent randomized trial found that a similarly intensive intervention did not reduce readmissions in a vulnerable elderly patient population. The authors of this study note that difficulty in communicating with primary care physicians, exacerbated by the lack of an integrated electronic medical record, may have contributed to the failure of the virtual ward at preventing readmissions.