Beyond Length of Stay: Patient and Carer Perspectives on Virtual Hospital Pathways Following Colorectal Surgery
- 1Imperial College London
Abstract
BackgroundVirtual hospital (VH) pathways support early discharge through remote monitoring, but limited evidence has hindered implementation in colorectal surgery. This study aimed to define patient-and carer-relevant outcomes and experiences of VH following colorectal surgery.
MethodologyA patient and public involvement and engagement (PPIE) consultation was conducted with 8 participants (7 patients, 1 carer; 4 women, 4 men) who had experienced VH following bowel resection at a high-volume robotic unit. Purposive sampling ensured that 50% of participants had experienced readmission. The 90-minute session was delivered via Microsoft Teams. Data were analysed using reflexive thematic analysis.
ResultsSeven themes were identified: readmission, remote monitoring, carer burden, recovery, equity, readiness for discharge, and information delivery. Patients supported early discharge when remote monitoring enabled timely detection of complications and readmission pathways were efficient. Readmission was not perceived as failure but as appropriate escalation. Dissatisfaction with readmission was related to delays in emergency care. Remote monitoring provided psychological safety, with patients feeling "held" at home. Carers assumed substantial, often unrecognised, quasi-clinical roles. Recovery was defined by return to function rather than length of stay. Equity concerns were evident, with VH favouring those with adequate support at home, digital literacy, and language proficiency. Discharge readiness was both clinical and psychological. Information delivery at discharge was often poorly retained and requires reinforcement preoperatively at every encounter with patients and carers.
ConclusionsVH pathways are acceptable and valued. Readmission is a marker of system responsiveness rather than failure of early discharge on VH. Psychological preparedness, carer support, and equitable access are critical to successful and scalable implementation of early discharge using a virtual hospital.
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BibTeX
@misc{reza2026beyond,
title = {{Beyond Length of Stay: Patient and Carer Perspectives on Virtual Hospital Pathways Following Colorectal Surgery}},
author = {L. Reza and Z. Arabi and H. Ward and L. Payne and J. Kinross and V. Patel},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.24.26361282},
url = {https://www.medrxiv.org/content/10.64898/2026.08.24.26361282v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Beyond Length of Stay: Patient and Carer Perspectives on Virtual Hospital Pathways Following Colorectal Surgery
AU - L. Reza
AU - Z. Arabi
AU - H. Ward
AU - L. Payne
AU - J. Kinross
AU - V. Patel
PY - 2026
DA - 2026/08/24
PB - medRxiv
DO - 10.64898/2026.08.24.26361282
UR - https://www.medrxiv.org/content/10.64898/2026.08.24.26361282v1
AB - BackgroundVirtual hospital (VH) pathways support early discharge through remote monitoring, but limited evidence has hindered implementation in colorectal surgery. This study aimed to define patient-and carer-relevant outcomes and experiences of VH following colorectal surgery. MethodologyA patient and public involvement and engagement (PPIE) consultation was conducted with 8 participants (7 patients, 1 carer; 4 women, 4 men) who had experienced VH following bowel resection at a high-volume robotic unit. Purposive sampling ensured that 50% of participants had experienced readmission. The 90-minute session was delivered via Microsoft Teams. Data were analysed using reflexive thematic analysis. ResultsSeven themes were identified: readmission, remote monitoring, carer burden, recovery, equity, readiness for discharge, and information delivery. Patients supported early discharge when remote monitoring enabled timely detection of complications and readmission pathways were efficient. Readmission was not perceived as failure but as appropriate escalation. Dissatisfaction with readmission was related to delays in emergency care. Remote monitoring provided psychological safety, with patients feeling "held" at home. Carers assumed substantial, often unrecognised, quasi-clinical roles. Recovery was defined by return to function rather than length of stay. Equity concerns were evident, with VH favouring those with adequate support at home, digital literacy, and language proficiency. Discharge readiness was both clinical and psychological. Information delivery at discharge was often poorly retained and requires reinforcement preoperatively at every encounter with patients and carers. ConclusionsVH pathways are acceptable and valued. Readmission is a marker of system responsiveness rather than failure of early discharge on VH. Psychological preparedness, carer support, and equitable access are critical to successful and scalable implementation of early discharge using a virtual hospital.
ER -