Background Community palliative care complexities are increasing, with more patients choosing home as their final place of care (Vernon, Hughes, Kowalczyk. Soc Sci Med. 2022; 296:114731). NHS England has directed Integrated Care Systems to expand or introduce Virtual Ward models, proven to substantially reduce unnecessary hospital admissions (NHS England. Supporting information for ICS leads [internet]. 2022; Jones, Carroll. Br J Comm Nurs. 2014; 19(7):330–4). Although many patients desire to remain home, others express preference for hospital escalation when needed, as outlined in their Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) (Hawkes, Fritz, Deas, et al. Resuscitation. 2020; 148:98–107). The ‘Ambitions for Palliative and End of Life Care’ framework (National Palliative and End of Life Care Partnership. 2021) emphasises the necessity for care that is individualised and coordinated, therefore Virtual Ward must balance minimising unwanted admissions and enabling necessary hospital escalations.

Aims To prevent avoidable hospital admissions while simultaneously facilitating appropriate escalation. To evaluate the clinical appropriateness of hospital admissions for patients managed by Virtual Ward.

Method Patients on Virtual Ward receive daily virtual assessments and bi-weekly consultant reviews as part of an intensive multidisciplinary care approach. A retrospective case note review was conducted for patients hospitalised in a one year period between April 2023 and March 2024. Data on admission reasons, outcomes, primary diagnoses, ReSPECT statuses, and demographics were analysed by two independent doctors.

Results 755 patients were admitted to Virtual Ward; 53 were hospitalised, representing 7.02% of the total. Primary reasons included sepsis/infection, suspected cord compression, and deranged blood results, predominantly among patients with metastatic malignancies. 18 (34.0%) escalations were initiated by external healthcare teams. 58.5% of escalations were in keeping with ReSPECT; in remaining cases, plans were unclear or absent. 90.6% of admissions were deemed clinically appropriate, considering the overall clinical context.

Conclusion Hospital admissions from Virtual Ward aligned well with clinical needs and ReSPECT plans, highlighting the importance of robust escalation plans. Virtual Wards not only help prevent unnecessary admissions but also facilitate early detection of critical symptoms needing escalation.