Virtual Hospital Research Articles

Management of COVID-19 in the community using virtual care: An Australian perspective

Introduction Virtual care and remote monitoring were widely used during the COVID-19 pandemic. However, early evaluations of effectiveness were often inconclusive due to low rates of enrolment and limited data. The aim of this study was to evaluate the effectiveness of virtual care in managing individuals in community-based self-isolation and quarantine in Australia during this pandemic. Methods A retrospective cross-sectional study was conducted of individuals admitted to a virtual hospital in Sydney who either tested positive for COVID-19 and required self-isolation, or tested negative but still needed to self-isolate, amidst the Delta wave of the COVID-19 pandemic. Outcome measures included health service utilisation, in-hospital mortality, patient-reported experience measures (PREM), and cost savings resulting from avoided emergency department (ED) presentations. Results Out of 9571 individuals admitted, 8544 (89.3%) had COVID-19. Clinical deterioration or acute illness occurred in 2477 (25.9%) individuals, of whom 890 (9.3%) were referred to ED for further assessment or investigation, and 614 (6.4%) were admitted for inpatient treatment. Overall mortality was 0.2%. Out of 1020 individuals who completed the PREM survey, 846 (82.9%) rated the overall virtual care experience as ‘good’ or ‘very good’. Avoided ED presentations possibly resulted in cost savings estimated between AU$691,214 and AU$2,994,540. Conclusion Virtual care was successfully used to manage a large number of individuals in community-based self-isolation and quarantine during the COVID-19 pandemic. Scalable pathways for triage, monitoring and clinical escalation via telehealth ensured patient safety and acceptability, and alleviated strain on the broader health system.

Virtual Hospitals and Patient Experience: Protocol for a Mixed Methods Observational Study.

Virtual care is increasingly incorporated within routine health care settings to improve patient experience and access to care. A patient's experience encompasses all the interactions an individual has with the health care system. This includes a greater emphasis on actively involving carers in the decisions and activities surrounding a patient's health care. This study aimed to investigate the variety of health care delivery challenges encountered in a virtual hospital and explore potential ways to improve the patient experience. Focusing on acute respiratory, this protocol outlines a mixed methods study exploring the patient experience of a virtual hospital in Australia, Royal Prince Alfred Virtual Hospital (rpavirtual). We will use an exploratory mixed methods approach comprising of secondary data analysis, observations, interviews, and co-design focus groups. Participants will include patients, their carers, and health care workers who are involved in the acute respiratory virtual hospital model of care. Together, the data will be triangulated to explore views and experiences of using this model of care, as well as co-designing recommendations for further improvement. Findings from this study will identify current barriers and facilitators to implementing virtual care, such as work-as-done versus work-as-imagined, equity of care, the role of carers, and patient safety during virtual care. As of August 2024, a total of 25 participants have been interviewed. This protocol outlines a mixed methods case study on the acute respiratory model of care from Australia's first virtual hospital, rpavirtual. This study will collect the experiences of patients, carers, and health care workers to co-design a series of recommendations to improve the patient experience. DERR1-10.2196/58683.

A Retrospective Study of Virtual Hospital Experiential Learning Across Clerkship and Pre-clerkship Doctor of Osteopathic Medicine Students at a Medical School Based in the United States

A Retrospective Study of Virtual Hospital Experiential Learning Across Clerkship and Pre-clerkship Doctor of Osteopathic Medicine Students at a Medical School Based in the United States

Process and implementation evaluation of a virtual hospital model of care for low back pain (Back@Home).

Low back pain was the sixth most common reason for an ED visit in 2022-2023 in Australia, one-third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes. Ethics approval was granted for protocols X21-0278 & 2021/ETH10967 and X21-0094 & 2021/ETH00591. We conducted a mixed-method process evaluation, using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care. This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724-AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function. Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non-serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.

The Rise of Virtual Health Care: Transforming the Health Care Landscape in the Kingdom of Saudi Arabia: A Review Article.

Background: The rise of virtual healthcare underscores the transformative influence of digital technologies in reshaping the healthcare landscape. As technology advances and the global demand for accessible and convenient healthcare services escalates, the virtual healthcare sector is gaining unprecedented momentum. Saudi Arabia, with its ambitious Vision 2030 initiative, is actively embracing digital innovation in the healthcare sector. Methods: In this narrative review, we discussed the key drivers and prospects of virtual healthcare in Saudi Arabia, highlighting its potential to enhance healthcare accessibility, quality, and patient outcomes. We also summarized the role of the COVID-19 pandemic in the digital transformation of healthcare in the country. Healthcare services provided by Seha Virtual Hospital in Saudi Arabia, the world's largest and Middle East's first virtual hospital, were also described. Finally, we proposed a roadmap for the future development of virtual health in the country. Results and conclusions: The integration of virtual healthcare into the existing healthcare system can enhance patient experiences, improve outcomes, and contribute to the overall well-being of the population. However, careful planning, collaboration, and investment are essential to overcome the challenges and ensure the successful implementation and sustainability of virtual healthcare in the country.

The Use of Immersive Virtual Reality Training for Developing Nontechnical Skills Among Nursing Students: Multimethods Study.

Immersive virtual reality (IVR) is a niche technology rising in popularity in nursing education. Although there is an abundance of evidence to demonstrate the effect of virtual reality (VR) on desired learning outcomes, this evidence is limited to technical or procedural skills or managing a single patient with clinical problems. Nontechnical skills (NTS), such as communication, decision-making, teamwork, situation awareness, and managerial skills, have not been explored using IVR technology. This study aimed to (1) investigate the potential efficacy of the IVR system virtual reality hospital (VR-Hospital, or VR-Hosp), a single-user game we developed, on nursing students' NTS, sense of presence in the virtual clinical environment, and satisfaction and self-confidence in learning; (2) identify variables that predict NTS; and (3) explore students' experience in using VR-Hosp. A multimethods design with a quantitative and qualitative approach was adopted. Participants were provided with VR-Hosp with 3 scenarios in training. VR-Hosp adopted a multibed, multipatient, multitask approach and was embedded with various clinical situations. Learning outcomes were measured after the training, followed by group interviews. In total, 202 students joined the study. Results revealed high levels of satisfaction and self-confidence in learning. Significant achievement in NTS was perceived by the students. The levels of satisfaction and self-confidence in learning and the involvement and sensory fidelity domains in the sense of presence were positive predictors of NTS. The promising results offer a basis for designing IVR activities for nursing education. Further investigations are imperative to determine the impact of IVR technology on learning outcomes in clinical practice.

Studying Provider’s Satisfaction on Video Consultation by Ain Shams University Virtual Hospital

Abstract Background Video consultations were developed to allow long-distance patient and clinician contact, care, advice and monitoring which has been shown to improve patient health status. When rural settings, lack of transport, a lack of mobility, decreased funding, or a lack of staff restrict access to care, video consultation may bridge the gap. Objective To measure satisfaction of physicians involved in video consultations services provided at Ain Shams Virtual Hospitals (AVH). To identify the main factors affecting satisfaction of physicians involved in such video consultations services provided at AVH. Methods A descriptive cross-sectional study was conducted to measure satisfaction of a sample of providers of video consultations at AVH from December 2020 to March 2021. Results Total 37 physicians were included in the study, 29 physicians responded (78.3%). The mean age ±SD is 37.97 ±6.3 and their main specialties were neuropsychiatry (40.7%), internal medicine subspecialties (40.7%), and surgical specialties (18.5%). About 83% were confident with their diagnoses in video consultations and (13.8%, 75.9%) of the physicians reported that they always/sometimes suffered from bad quality of image/sound respectively. More than half of the physicians (53.5%) thought that lack of physical examination would affect the accuracy of the diagnoses and 53.5% of the physicians thought that video consultation would be suitable for follow-up patients post operatively. Conclusion Two thirds of the physicians had a positive experience and were satisfied with using video consultations in their clinical practices. Recommendations It is recommended to use video consultations in following-up of patients. It is also recommended to monitor provider`s satisfaction over time.

The Regional Ain Shams Telemedicine Network

Abstract With the deficiency in specialized care and low resources it is vital to come up with new healthcare delivery systems that utilize available resources in an efficient way. The hub-spoke model is not new but has recently been revisited as it aids in sharing of specialized services. A central hub is able to support attached spokes through physical and virtual healthcare services. To manage such a network a strong software platform with several integral features should be in place. Using available solutions may not satisfy all required features and may fragment the patient’s health records. Ain Shams University Virtual Hospital (AVH) dedicated to healthcare transformation in Egypt and the region, manages and connects its spokes through TREAT platform (The REgional Ainshams Telemedicine network) that was funded by the Science and Technology Development Fund. The software platform supports provider-to-provider (P2P) telemedicine but for the sake of continuity of care other telemedicine modules and physical services are present. It helps utilize available resources in an efficient way with the capacity to audit user and system performance. The patient module has a seperate entry point and integrates with the rest of the system. Inpatients and outpatients from inside the system and outside can be managed physically and remotely.

The Impact of Design Factors on User Behavior in a Virtual Hospital Room to Explore Fall Prevention Strategies.

Falls in hospitals pose a significant safety risk, leading to injuries, prolonged hospitalization, and lasting complications. This study explores the potential of augmented reality (AR) technology in healthcare facility design to mitigate fall risk. Few studies have investigated the impact of hospital room layouts on falls due to the high cost of building physical prototypes. This study introduces an innovative approach using AR technology to advance methods for healthcare facility design efficiently. Ten healthy participants enrolled in this study to examine different hospital room designs in AR. Factors of interest included room configuration, door type, exit side of the bed, toilet placement, and the presence of IV equipment. AR trackers captured trajectories of the body as participants navigated through these AR hospital layouts, providing insights into user behavior and preferences. Door type influenced the degree of backward and sideways movement, with the presence of an IV pole intensifying the interaction between door and room type, leading to increased sideways and backward motion. Participants displayed varying patterns of backward and sideways travel depending on the specific room configurations they encountered. AR can be an efficient and cost-effective method to modify room configurations to identify important design factors before conducting physical testing. The results of this study provide valuable insights into the effect of environmental factors on movement patterns in simulated hospital rooms. These results highlight the importance of considering environmental factors, such as the type of door and bathroom location, when designing healthcare facilities.

A new ventilation performance index considering relative changes in environmental parameters: A numerical study

The ventilation index plays a crucial role in evaluating and selecting ventilation systems. However, existing studies focus only on the "effectiveness" of ventilation systems but usually ignore the "extent of the effect" caused by ventilation, and no relevant indexes are available. To address this issue, this study aims to propose a new ventilation index named the equivalent ventilation number (EVN), which considers the relative change in environmental parameters. The application potential of the EVN index was numerically examined in a virtual hospital ward setting with varying air changes per hour (ACH), thermal loads, air distribution patterns, contaminant source intensities, and local air supply rates. The results demonstrate that the highest average temperature-based EVN and CO2-based EVN are obtained when ACH increases from 6 h−1 to 12 h−1 and local supply air velocity increases from 0 m/s to 1 m/s, with values of 0.66 and 1.49 respectively. Furthermore, EVN values differ across different ventilation conditions and locations. The effect of changing ventilation conditions on ventilation performance assessed by heat removal effectiveness and temperature-based EVN, as well as contaminant removal effectiveness and CO2-based EVN, is opposite in 4 out of 10 cases and 3 out of 10 cases, respectively. The average EVN values calculated based on temperature and contaminant changes differ among all cases, with the largest difference of 1.2. The proposed EVN is anticipated to be an effective index for quantifying and comparing the "extent of the effect" caused by ventilation systems under various ventilation conditions.

Effects of Immersive Straight Catheterization Virtual Reality Simulation on Skills, Confidence, and Flow State in Nursing Students.

Core nursing procedures are essential for nursing students to master because of their high frequency in nursing practice. However, the experience of performing procedures in actual hospital settings decreased during the coronavirus disease 2019 pandemic, necessitating the development of various contents to supplement procedural training. This study investigated the effects of a straight catheterization program utilizing an immersive virtual reality simulation on nursing students' procedural performance, self-confidence, and immersion. The study employed a nonequivalent control group pretest-posttest design with 29 participants in the experimental group and 25 in the control group. The experimental group received training through a computer-based immersive virtual reality program installed in a virtual reality hospital, with three weekly sessions over 3 weeks. The control group underwent straight catheterization using manikin models. The research findings validated that virtual reality-based straight catheterization education significantly improved students' procedural skills, self-confidence, and flow state. Therefore, limited practical training can be effectively supplemented by immersive virtual reality programs.

An immersive virtual reality communication skills training for dietitians: A feasibility study

ObjectiveThe training of dietitians emphasizes the development of strong communication skills. Immersive virtual reality (IVR) has been successfully employed for various healthcare scenarios; however, it is yet understudied in dietetics education. Therefore, we conducted a feasibility study to investigate the usefulness of IVR for the purpose of communication skills training. MethodsWe designed a multi-user virtual hospital environment that enabled the training of professional conversations between dietitians and patients. Divided into groups of three, 30 dietetics students participated in a role-play task. Taking a qualitative approach to inquiry, we evaluated how participants assessed the benefits and limitations of the IVR training. ResultsParticipants appreciated the authenticity of the training environment and mentioned various advantages of IVR (e.g., sense of privacy, better focus on conversation) over traditional modes of instruction. On the other side, participants frequently mentioned that the lack of avatars' facial expressions might present an obstacle for effective communication skills training. ConclusionIVR enables authentic communication skills trainings for dietitians. Special consideration should be given to providing ample social cues during training. InnovationThe study demonstrates that the promising results from other healthcare professions regarding the usefulness of IVR training also apply to dietetics.

Virtual hospital care development and deployment:Arapid qualitative study of frontline clinicians and leaders.

Virtual hospitalist programs are rapidly growing in popularity due to worsening clinician shortages and increased pressure for flexible work options. These programs also have the potential to establish sustainable staffing models across multiple hospitals optimizing cost. We aimed to explore the current state of virtual hospitalist services at various health systems, challenges and opportunities that exist in providing virtual care, and future opportunities for these types of services. To identify perspectives on design and implementation of virtual hospitalist programs from academic hospitalist leaders. We conducted focus groups with United States academic hospitalist leaders. Semistructured interviews explored experiences with virtual hospitalist programs. Using rapid qualitative methods including templated summaries and matrix analysis, focus group recordings were analyzed to identify key themes. We conducted four focus groups with 13 participants representing nine hospital systems across six geographic regions and range of experience with virtual hospital medicine care. Thematic analysis identified three themes: (1) a broad spectrum of virtual care delivery; (2) adoption and acceptance of virtual care models followed the stages of diffusion of innovation; and (3) sustainability and scalability of programs were affected by unclear finances. Hospitalist leader perspectives revealed complex factors influencing virtual care adoption and implementation. Addressing concerns about care quality, financing, and training may accelerate adoption. Further research should clarify the best practices for sustainable models optimized for access, hospitalist experience, patient safety, and financial viability.

Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components

BackgroundTechnology-enabled inpatient-level care at home services, such as virtual wards and hospital at home, are being rapidly implemented. This is the first systematic review to link the components of these service delivery innovations to evidence of effectiveness to explore implications for practice and research.MethodsFor this review (registered here https://osf.io/je39y), we searched Cochrane-recommended multiple databases up to 30 November 2022 and additional resources for randomised and non-randomised studies that compared technology-enabled inpatient-level care at home with hospital-based inpatient care. We classified interventions into care model groups using three key components: clinical activities, workforce, and technology. We synthesised evidence by these groups quantitatively or narratively for mortality, hospital readmissions, cost-effectiveness and length of stay.ResultsWe include 69 studies: 38 randomised studies (6413 participants; largely judged as low or unclear risk of bias) and 31 non-randomised studies (31,950 participants; largely judged at serious or critical risk of bias). The 69 studies described 63 interventions which formed eight model groups. Most models, regardless of using low- or high-intensity technology, may have similar or reduced hospital readmission risk compared with hospital-based inpatient care (low-certainty evidence from randomised trials). For mortality, most models had uncertain or unavailable evidence. Two exceptions were low technology-enabled models that involve hospital- and community-based professionals, they may have similar mortality risk compared with hospital-based inpatient care (low- or moderate-certainty evidence from randomised trials). Cost-effectiveness evidence is unavailable for high technology-enabled models, but sparse evidence suggests the low technology-enabled multidisciplinary care delivered by hospital-based teams appears more cost-effective than hospital-based care for those with chronic obstructive pulmonary disease (COPD) exacerbations.ConclusionsLow-certainty evidence suggests that none of technology-enabled care at home models we explored put people at higher risk of readmission compared with hospital-based care. Where limited evidence on mortality is available, there appears to be no additional risk of mortality due to use of technology-enabled at home models. It is unclear whether inpatient-level care at home using higher levels of technology confers additional benefits. Further research should focus on clearly defined interventions in high-priority populations and include comparative cost-effectiveness evaluation.Trial registrationhttps://osf.io/je39y.

Metaverse-based cardiac magnetic resonance imagingsimulation application for overcoming claustrophobia: a preliminary feasibility trial.

Introduction: Cardiac magnetic resonance imaging (CMR) is vital, but claustrophobia affects 10% of patients. The metaverse, an immersivevirtual and augmented reality environment, has healthcare potential. We present a metaverse-based CMR simulation for claustrophobic patients. Methods: Three cardiomyopathy patients, initially CMR-refusing due to claustrophobia, received training via a virtual reality headset in a metaverse-based virtual hospital. Training efficacy was assessed through questionnaires and anxiety scales. Results: The patients successfully completed metaverse-based training, adapting to the CMR simulation. On CMR day, all entered the machine without issues and with reduced anxiety. Patients found the training useful, suggesting platform familiarization. Discussion: Our study demonstrates the metaverse's potential in alleviating CMR-related claustrophobia. The immersive nature enhances patient preparation, although usability improvements are needed. Further research should compare this approach with alternatives.

Are serious games seriously good at preparing students for clinical practice?: A randomized controlled trial

Purpose Serious games (SGs) have great potential for pediatric medical education. This study evaluated the efficacy of a SG in improving learner satisfaction, knowledge, and behavior. Materials and methods This was an investigator-blinded randomized controlled trial (RCT) comparing a SG against two controls: (i) adaptive tutorial (AT), and (ii) low-stimulus control (LSC). SG is a highly immersive role-playing game in a virtual hospital. AT delivers interactive web-based lessons. LSC is paper-based clinical practice guidelines. Metropolitan senior medical students at UNSW were eligible. A total of 154 enrolled and were block randomized to one intervention. Participants had access to one intervention for 8 weeks which taught pediatric acute asthma and seizure assessment and management. Satisfaction was assessed with Likert-scale responses to 5 statements and 2 free-text comments. Knowledge was assessed with 10 multiple-choice questions (MCQs). Clinical behavior was assessed during a 30-point simulated clinical management scenario (CMS). Primary analysis was performed on a modified intention-to-treat basis and compared: (1) SG vs. AT; and (2) SG vs. LSC. Results A total of 118 participants were included in the primary analysis (modified intention-to-treat model). No significant differences in MCQ results between the SG and control groups. SG group outperformed the LSC group in the CMS, with a moderate effect (score out of 30: 20.8 (3.2) vs. 18.7 (3.2), respectively, d = 0.65 (0.2–1.1), p = 0.005). No statistically significant difference between SG and AT groups in the CMS (score: 20.8 (3.2) vs. 19.8 (3.1), respectively, d = 0.31 (–0.1 to 0.8), p = 0.18). A sensitivity analysis (per-protocol model) was performed with similar outcomes. Conclusions This is the first investigator-blinded RCT assessing the efficacy of a highly immersive SG on learner attitudes, knowledge acquisition, and performance in simulated pediatric clinical scenarios. The SG demonstrated improved translation of knowledge to a simulated clinical environment, particularly compared to LSC. SGs show promise in pediatric medical education.

The Health Outcomes of a Telegeriatrics Follow-Up Model on Dementia Patients and Their Caregivers in Cairo.

Background/Purpose: Older patients living with dementia and their caregivers are ideal beneficiaries of telemedicine, cost-effectiveness, caregiver satisfaction, and physician acceptance. The aim is to study the effect of a telemedicine dementia enabled program on the health outcome of dementia patients and their caregivers, as regard the patient outcome, caregiver stress, and caregiver satisfaction. Methods: Ninety-seven (n = 97) elderly subjects were recruited from the outpatient clinics and inpatient ward of Geriatrics Hospital, Ain Shams University Hospitals. Seventy subjects completed 6 months of follow-up using a telegeriatrics model. Patient outcomes (delirium, behavioral and psychological symptoms of dementia [BPSD], and need for home consultations, emergency room [ER] visits, clinic visits, and hospital admissions) were assessed and followed. Caregiver stress was evaluated and monitored using the abridged Arabic version of the Zarit Burden Interview ZBI-A. Caregiver satisfaction was assessed using dedicated satisfaction questionnaire designed by Ain Shams Virtual Hospital. Results: elirium episodes, BPSD episodes, and the need for home consultations, clinic visits, ER visits, and hospital admissions. This was statistically significant after the second, fourth, and sixth months of follow-up (p-value <0.001). In addition, the telegeriatrics follow-up model had a positive effect on both caregiver stress and caregiver satisfaction. Conclusions: The telegeriatrics follow-up model is a useful tool in the improvement of health outcomes of dementia patients, reduction of caregiver stress, and achievement of caregiver satisfaction.

A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study.

Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an "audit and feedback" process. The implementation of "Back@Home" will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. PRR1-10.2196/50146.

Innovative Models of Care for Hospitals of the Future.

New ways of providing acute care outside of traditional hospital building complexes, such as virtual care or hospital in the home, are becoming more common. Despite this, many hospitals are still conceived as "bricks and mortar" centralised constructions, and few health service infrastructure organisations meet intensively with consumers or clinicians prior to conceptualising hospital design. Our study sought to understand the needs and expectation of community members and healthcare providers, and co-design innovative models of acute care to inform development of a new metropolitan hospital in Australia. Our study used a three-step approach, consisting of academic and grey literature reviews; a demographic analysis of the hospital catchment population; and a series of 20 workshops and 6 supplementary interviews with community members and local healthcare providers. We found that care should be tailored to the healthcare needs and expectations of each consumer, with consumers cared for in the community where possible and safe. We propose an innovative model of care for hospitals of the future, consisting of fully integrated acute care underpinned by appropriate digital architecture to deliver care that is community focussed. It is vital that new hospitals build in sufficient adaptability to leverage future innovation and meet the needs of growing and changing communities.

Virtual Healthcare Revolution: Understanding Nurse Competencies and Roles.

Digital healthcare, especially virtual health, has changed nurses' jobs and skills. In the evolving healthcare landscape, nurses healthcare landscape is increasingly required to have diverse competencies to navigate the world of virtual health effectively. This study aims to qualitatively explore the role of nurses in virtual health and the competencies required to work in virtual health in Saudi Arabia, with a specific focus on SEHA virtual hospital. An online open survey with nursing experts was employed as the qualitative method approach during the initial phase of an online Delphi study design. Twelve core competencies were identified: digital technology proficiency, professionalism, clinical expertise, leadership, legal and ethical considerations, care coordination, documentation, effective communication, patient assessment and diagnosis, patient safety, patient-centered care, and remote patient monitoring. The research emphasizes the crucial role of nurses in virtual hospitals and clinics, contributing to the expansion of the virtual healthcare environment. It presents a thorough competency framework that can guide the development of training programs and policies, enhancing the effectiveness of virtual healthcare delivery. The study provides a foundational competencies list that can guide the development of comprehensive training programs for nurses in virtual healthcare. Policymakers and educational leaders are encouraged to use these findings to create standardized practices and policies, enhancing the effectiveness and efficiency of virtual healthcare delivery.