Purpose: Numerous transitional care interventions have been proposed to improve care transitions from hospital to home and reduce avoidable hospital readmissions among chronically ill older patients. The virtual ward (VW) is an intervention that aims to reduce this risk by providing follow-up care for patients discharged from the hospital. In 2015, a family medicine-based VW was implemented at the Jewish General Hospital, in Montreal, Canada. This intervention involves care coordination and follow-up by the multidisciplinary primary health care team. This study provides a description of the family medicine-based VW and its implementation to guide health care providers seeking to adapt this intervention to their own setting. Methods: A retrospective qualitative study was conducted. Data was obtained from semi-structured group interviews with the VW team and health professionals from two other hospitals, and from informal discussions with members of the VW team. An inductive narrative approach was used for data analysis. Results: The design of the family medicine-based VW was informed by a systematic review of transitional care interventions. The team adapted the VW to utilize existing processes and identified three distinct modules that implementers should consider: discharge planning, case management, and weekly multidisciplinary rounds. The following were identified as key factors in the implementation process: 1) funding, 2) home care, 3) communication, 4) standardization of protocols, 5) quality improvement, and 6) positive reception. Conclusions: The family medicine-based VW addresses the care of frequent health system users and compensates for gaps in communication and coordination. This research may be useful in informing family medicine-based VW implementation initiatives by providing contextual detail about the family medicine-based VW, its implementation process, and factors that facilitated its implementation in a Montreal hospital. [ABSTRACT FROM AUTHOR]