Virtual nursing implementation and 30-day patient readmissions: a multi-site study

Current nursing workload and staffing shortages have been associated with adverse patient outcomes, including readmissions. Virtual Nursing (VN) is an emerging care delivery model that shifts selected clinical tasks from bedside nurses to remotely located virtual nurses, but its impact on patient outcomes remains unclear. We conducted a retrospective cohort study across nine hospitals in a major Southeastern U.S. health system, including adult patients discharged from inpatient units during the 12 months before and after VN implementation between 2022 and 2024. VN-assisted discharges were compared with traditional in-person discharges using propensity score matching and staggered difference-in-differences analyses. After matching, 4662 VN-assisted and 4662 in-person discharge encounters were included. Patients discharged through VN had lower 30-day emergency department readmission rates than those receiving traditional discharge care (3.7% vs. 13.3%; P < 0.001), despite similar baseline readmission risk scores. VN was associated with a lower readmission risk (risk ratio, 0.28; 95% CI, 0.24-0.33) and absolute risk difference (-0.10; 95% CI, -0.11 to -0.08). Similar reductions were observed in both urban and rural hospitals. These findings suggest that centralized VN-supported discharge may improve discharge processes without worsening short-term patient outcomes.