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Background The use of virtual care has increased dramatically in response to the COVID-19 pandemic, yet evidence is lacking regarding the impact of virtual care on patient outcomes, particularly in pediatrics. A standardized evaluation approach is required to support the integration of virtual care into pediatric health care delivery programs. The objective of this work was to develop a comprehensive and structured framework for pediatric virtual care evaluation. This framework is intended to engage and guide care providers, health centres, and stakeholders towards the development of a standardized approach to the evaluation of pediatric virtual care. Methods We brought together a diverse multidisciplinary team, including pediatric clinicians, researchers, digital health leads and analysts, program leaders, a human factors engineer, a family advisor and our manager of health equity and diversity. The team reviewed the literature, including published evaluation frameworks, and used a consensus-based method to develop a virtual care evaluation framework applicable to a broad spectrum of pediatric virtual care programs. We used an iterative process to develop framework components, including domains and sub-domains, examples of evaluation questions, measures, and data sources. Team members met repeatedly over seven months to generate and provide feedback on all components of the framework, making revision as needed until consensus was reached. The framework was then applied to an existing virtual care program. Results The resulting framework includes four domains (health outcomes, health delivery, individual experience, and program implementation) and 19 sub-domains designed to support the development and evaluation of pediatric virtual care programs. We also developed guidance on how to use the framework and illustrate its utility by applying it to an existing pediatric virtual care program. Conclusions This virtual care evaluation framework expands on previously developed frameworks by providing additional detail and a structure that supports practical application. It can be used to evaluate a wide range of pediatric virtual care programs in a standardized manner. Use of this comprehensive yet easy to use evaluation framework will inform appropriate implementation and integration of virtual care into routine practice and support its sustainability and continuous improvement.

Antipsychotic medication is the first-line treatment for people with psychosis in the State Hospital, Carstairs: Scotland's only high-security forensic hospital. The Clinical Standards for Schizophrenia (Clinical Standards Board for Scotland 2001) require clinicians to use standardised rating scales to monitor the side effects associated with medication. Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS) (Day et al 1995) was implemented in the hospital in December 2003. A baseline audit was carried out following its implementation to establish the incidence of side effects. Of those patients audited (n=152), 87 (57 per cent) reported either low or medium (n=51, 34 per cent) LUNSERS scores, indicating an acceptable level of medication tolerance. It is expected that clinicians will continue to use LUNSERS as part of their routine clinical practice to help inform patients and meet national standards.