Are virtual wards for children safe and effective? A 3-year retrospective service evaluation of an urban Hospital at Home service for children and young people.

Objective: Service evaluation of an urban 'Hospital at Home' service which provides care in patients' homes that would traditionally be delivered in the hospital setting.

Design: Retrospective longitudinal review of routinely collected data recorded contemporaneously for clinical use, analysed to elicit utilisation patterns and service impact.

Setting: A paediatric 'Hospital at Home' service delivered across two large acute hospitals, treating a total of 4427 patients across both primary and secondary care in South London from January 2018 to June 2022.

Patients: Children managed by the Hospital at Home service, aged 0-16 years MAIN OUTCOME MEASURES: We describe patient outcomes and service performance including data on demographics, diagnoses, referral sources, hospital reattendances and bed day savings.

Results: Over the evaluation period, 11 092 bed days were saved as a direct result of this service at a cost of 1.09-1.25 nursing contacts required per bed day. Reattendance to hospital was 11.1% over the study period, however, parent/carer-initiated reattendance resulting in hospital admission was only 2.7%.

Conclusion: Hospital at Home services are a policy priority for the English National Health Service because of their potential to reduce admissions to and enable early discharge from hospital. This evaluation provides insight into an urban population of children managed under Hospital at Home care and demonstrates its feasibility and effectiveness. Our novel approach to the analysis of hospital reattendance data may have the potential as a template for future performance analysis of similar services.