Why is implementing remote monitoring in virtual wards (Hospital at Home) for people living with frailty so hard? Qualitative interview study.

Background: There is relatively low uptake of remote monitoring on frailty virtual wards (Hospital at Home) compared to virtual wards caring for people with other medical conditions. However, reasons for low uptake are poorly understood.

Objectives: To explore the views and experiences of frailty virtual wards stakeholders involved in implementing remote monitoring.

Methods: We conducted qualitative interviews with 42 stakeholders involved in delivery, design or evaluation of frailty virtual wards based in the UK. Analysis was based on the constant comparative method.

Results: Many participants perceived that remote monitoring was only useful for a small sub-group of patients with frailty for a range of medical, practical and social reasons. Remote monitoring required new ways of working from patients, staff and carers. The nature of this work was not always sufficiently well understood, designed or supported. Procurement practices were also seen to be misaligned with service needs, resulting in provision of equipment that was not fit for purpose. A further challenge in implementing remote monitoring in frailty virtual wards lay in tensions between national-level standardisation and enabling local flexibility.

Conclusions: Implementing remote monitoring in frailty virtual wards is challenged by lack of consensus on its suitability for this population, the extent and nature of change in clinical practices and work systems design required, and issues relating to equipment and standardisation. More co-design effort is needed to inform decision-making on remote monitoring for those with frailty.