The emergency department is the physical and emblematic front door for many Australians to access urgent healthcare services.
However, healthcare services are evolving rapidly to meet the population’s changing needs. In recent years, we’ve seen growing use of telephone, video, and online health services, including the national healthdirect helpline, 13YARN (a crisis support service for First Nations people), state-funded lines like 13 HEALTH, and bulk-billed telehealth services, which have helped millions of Australians to access health care on demand and from home.
The emergency department is similarly expanding into new telehealth models to improve access to emergency medical care. Virtual emergency departments allow people to access the expertise of a hospital emergency department through their phone, computer, or tablet.
All Australian states and the Northern Territory have some form of virtual emergency department, at least in development, although not all of these services are currently available to the general public.
So what is a virtual emergency department, and when is it appropriate to consider using one?
How does a virtual emergency department work?
Such a department is set up to mirror the way you would enter the physical emergency department front door. First, you provide some basic information to administration staff. You are triaged by a nurse (this means they categorize the level of urgency of your case), and then you see the emergency department doctor. Generally, this all takes place in a single video call.
In some instances, virtual emergency department clinicians may consult with other specialists, such as neurologists, cardiologists, or trauma experts, to make clinical decisions.
A virtual emergency department is not suitable for managing medical emergencies that would require immediate resuscitation or potentially serious chest pains, difficulty breathing, or severe injuries.
A virtual emergency department is best suited to conditions that require immediate attention but are not life-threatening. These could include wounds, sprains, respiratory illnesses, allergic reactions, rashes, bites, pain, infections, minor burns, children with fevers, gastroenteritis, vertigo, high blood pressure, and many more.
People with these sorts of conditions and concerns may not be able to get in to see a GP straight away and may feel they need emergency advice, care, or treatment.
When attending the emergency department, they can be subject to long wait times and delayed specialist attention because more serious cases are naturally prioritized. Attending a virtual emergency department may mean they’re seen by a doctor more quickly, and can begin any relevant treatment sooner.
From the perspective of the healthcare system, virtual emergency departments redirect unnecessary presentations away from physical emergency departments, helping them be ready to respond to emergencies. Staff will not hesitate to direct callers to the physical emergency department if they believe it is an emergency.
The doctor in the virtual emergency department may also direct the patient to a GP or other health professionalif the patient’s condition can’t be assessed visually or if they need physical treatment.
The results so far
Virtual emergency departments have developed significantly over the past three years, predominantly driven by the COVID pandemic. We are now slowly starting to see assessments of these services.
A recent evaluation my colleagues and I did of Queensland’s Metro North Virtual Emergency Department found roughly 30 percent of calls were directed to the physical emergency department. This suggests that the virtual emergency department could effectively manage cases 70 percent of the time.
Preliminary data from a Victorian virtual emergency department indicates it curbed a similar rate of avoidable emergency department presentations — 72 percent of patients were successfully managed by them alone. A study on the cost-effectiveness of another Victorian virtual emergency department suggested it has the potential to generate savings in healthcare costs if it prevents physical emergency department visits.
Only 1.2 percent of people assessed in Queensland’s Metro North Virtual Emergency Department required unexpected hospital admission within 48 hours of being “discharged” from them. None of these cases were life-threatening, which indicates the virtual emergency department is very safe.
The service experienced an average growth rate of 65 percent each month over a two-year evaluation period, highlighting increasing demand and confidence in the service. Surveys suggested clinicians also view the virtual emergency department positively.
What now?
We need further research into patient outcomes and satisfaction, as well as the demographics of those using virtual emergency departments, and how these measures compare to the physical emergency department across different triage categories.
There are also challenges associated with virtual emergency departments, including those related to technology (connection and skills among patients and health professionals), training (for health professionals), and the importance of maintaining security and privacy.
Nonetheless, these services can potentially reduce congestion in physical emergency departments and offer greater convenience for patients.
Eligibility differs between different programs, so if you want to use a virtual emergency department, you may need to check your eligibility in your jurisdiction. Most can be accessed online, and some have direct phone numbers.
Jaimon Kelly, Senior Research Fellow in Telehealth delivered health services, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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