TY  - JOUR
AU  - Greene, Leanne
AU  - Rahja, Miia
AU  - Laver, Kate
AU  - Wong, Vun Vun
AU  - Leung, Chris
AU  - Crotty, Maria
PY  - 2024
DA  - 2024/6/27
TI  - Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study
JO  - JMIR Aging
SP  - e54774
VL  - 7
KW  - gerontology
KW  - geriatric
KW  - geriatrics
KW  - older adult
KW  - older adults
KW  - elder
KW  - elderly
KW  - older person
KW  - older people
KW  - ageing
KW  - aging
KW  - aged
KW  - telerehabilitation
KW  - rehabilitation
KW  - rehab
KW  - workflow
KW  - hospitalization
KW  - health services accessibility
KW  - accessibility
KW  - clinical decision-making
KW  - equipment failure
KW  - telemedicine
KW  - telehealth
KW  - tele-medicine
KW  - tele-health
KW  - virtual care
KW  - virtual health
KW  - virtual medicine
KW  - remote consultation
KW  - telephone consultation
KW  - video consultation
KW  - remote consultations
KW  - telephone consultations
KW  - video consultations
KW  - personnel
KW  - hospital
AB  - Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood. Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff’s perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery. Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework. Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families. Conclusions: In this qualitative study exploring health care staff’s experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW. 
SN  - 2561-7605
UR  - https://aging.jmir.org/2024/1/e54774
UR  - https://doi.org/10.2196/54774
DO  - 10.2196/54774
ID  - info:doi/10.2196/54774
ER  -