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Pu D, Cameron P, Chapman W, Greenstock L, Sanci L, Callisaya ML, Haines T. Virtual emergency care in Victoria: Stakeholder perspectives of strengths, weaknesses, and barriers and facilitators of service scale-up. Australas Emerg Care 2024; 27:102-108. [PMID: 37852805 DOI: 10.1016/j.auec.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Virtual emergency services have been proposed as an alternative service model to conventional in-person emergency department attendance. METHODS Twenty participants were interviewed: 10 emergency medicine physicians, 4 health care consumers, and 6 other health care professionals. Conventional content analysis was performed on the interview transcriptions to identify perceived strengths and weaknesses of the VED, and barriers and facilitators to scaling-up the VED. RESULTS VEDs are perceived as a convenient approach to provide and receive emergency care while ensuring safety and quality of care, however some patients may still need to attend the ED in person for physical assessments. There is currently a lack of evidence, guidelines, and resources to support their implementation. Most of the potential and existing barriers and facilitators for scaling-up the VED were related to their effectiveness, reach and adoption. Broader public health contextual factors were viewed as barriers, while potential actions to address resources and costs could be facilitators. CONCLUSIONS VEDs were viewed as a convenient service model to provide care, can not replace all in-person visits. Current policies and guidelines are insufficient for wider implementation. Most of the barriers and facilitators for its scaling-up were related to VED effectiveness and delivery.
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Affiliation(s)
- Dai Pu
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Monash Partners Academic Health Science Centre, Australia.
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Emergency and Trauma Centre, The Alfred Hospital, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Australia; Melbourne Academic Centre for Health, Australia
| | | | - Lena Sanci
- Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; The ALIVE National Centre for Mental Health Research Translation, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Australia; Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Australia; Monash Partners Academic Health Science Centre, Australia
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Accorsi TAD, Eduardo AA, Moreira FT, Morbeck RA, Köhler KF, Lima KDA, Pedrotti CHS. Adherence to Emergency Department Referral Criteria in a Direct-to-Consumer Telemedicine Center. Telemed J E Health 2024; 30:1418-1424. [PMID: 38377569 DOI: 10.1089/tmj.2023.0482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Background: The safety of direct-to-consumer telemedicine (TM) is closely related to red flag detection and correct referrals. The adherence to referral criteria from current guidelines is not well quantified. Objective: To analyze the emergency department (ED) referral rate and adherence to referral guidelines in TM encounters of acutely ill patients calling a center that adopts stewardship protocols. Methods: This is a retrospective observational unicentric study, between March 2020 and March 2022, with patients who spontaneously sought direct-to-consumer urgent virtual medical assistance. A video-based teleconsultation was provided immediately after connection. Physicians managed situations according to their clinical judgment. Current guidelines, containing specific guidance for referral if red flags were identified, were available for consultation. Physicians' semiannual performance feedback was carried out. We analyzed the patterns for referral to immediate face-to-face medical evaluation and the agreement degree with the institutional guidelines. Results: A total of 232,197 patients were available, and 14,051 (6.05%) patients were referred to ED. A total of 8,829 (68.4%) referrals were based in specific guidelines according to the International Classification of Diseases hypothesis, and 8,708 (98.6%) were justified according to guidelines. Diarrhea had the highest guidelines' adherence to referral (97.6%), followed by COVID-19 (90%), headache (84.2%), and conjunctivitis (78.8%). Policies did not support 5,222 (31.6%) referrals, though 5,100 (97.6%) of these were justified according to the doctor's clinical judgment. Conclusion: TM doctors' assessment of acutely ill patients has high rates of adherence to guidelines regarding referral. Stewardship protocol adoption provides high rates of red flag description, even in the referral of nonpolicy diseases.
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Kelly JT, Mitchell N, Campbell KL, Furlong K, Langley M, Clark S, Rushbrook E, Hansen K. Implementing a virtual emergency department to avoid unnecessary emergency department presentations. Emerg Med Australas 2024; 36:125-132. [PMID: 37941299 DOI: 10.1111/1742-6723.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE EDs are necessary for urgent health concerns; however, many physical ED visits could be better treated in alternate settings. The present study aimed to describe the feasibility, acceptability and effectiveness of a Virtual ED to reduce unnecessary physical ED presentations at a large tertiary health service in Australia. METHODS This observational study using the RE-AIM framework (Reach, Efficacy, Adoption, Implementation and Maintenance) evaluated the feasibility of a Virtual ED using routinely collected health service data and process-evaluation to assess intervention fidelity and adherence between April 2020 and 31 March 2022. The primary outcome for the present study was the feasibility of the Virtual ED model of care. RESULTS The Virtual ED received 2080 direct calls for patients with a mean age of 50.3 years, with 70.4% managed in the Virtual ED alone and 29.6% referred for physical ED presentation. Of the 2080 direct referrals, 95.8% were potentially avoidable ED presentations. Of those referred, 28.3% required an admission. Of calls managed entirely by Virtual ED, 18 (1.2%) unexpectedly required a hospital admission within 48 h. General practitioner respondents rated the Virtual ED service as helpful to very helpful. The service had an average of 212 referrals per month, with a 65.2% average growth rate. The Virtual ED service was considered helpful and clinically appropriate, with a high level of ED avoidance. CONCLUSION The Virtual ED prevented 70% of community triaged patients from presenting to the physical ED, with good uptake from all referrers, supporting the use of virtual care pathways in emergency care management.
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Affiliation(s)
- Jaimon T Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Mitchell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Virtual Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Karen Furlong
- Virtual Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Caboolture Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Matthew Langley
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Virtual Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Sean Clark
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Virtual Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Caboolture Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Elizabeth Rushbrook
- Virtual Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Kim Hansen
- Virtual Emergency Department, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Sri-Ganeshan M, Underhill A, Charteris C, McGee F, Cameron PA. Establishing a 'Virtual' model of emergency care in Melbourne's southeast. AUST HEALTH REV 2023; 47:684-688. [PMID: 37939714 DOI: 10.1071/ah23070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
Digital technologies, specifically those required to facilitate telehealth via an audiovisual medium, are now at a standard that allows them to reliably assess patients with acute complaints within their homes. The coronavirus disease 2019 (COVID-19) pandemic forced innovation and led to an increased acceptance of telehealth from both clinicians and patients and presented an opportunity to incorporate telehealth into emergency medicine practice. With inpatient capacity strain exacerbated by the pandemic, three hospital networks within Melbourne's geographical southeast collaborated with Ambulance Victoria (AV) to set up a virtual emergency department (VED) service in January 2022. This service aimed to allow certain patients to receive care in the more convenient setting of their homes. Referrals were made directly by AV personnel at the home while they were attending to these patients. Consultation with a VED clinician was initiated through a secure audiovisual platform, 'Healthdirect'. Following this consultation, care could be facilitated at home through the VED clinician providing advice regarding treatment that paramedics could administer or through linkage into one of the various outreach services provided by the organisations. The VED represents part of the initial integration of telehealth into our organisations. We hope our initial framework might be built upon through greater integration with community services and incorporating more digital technologies. The ongoing graded expansion of telehealth services within our organisations will likely see more and more patients managed in their own homes.
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Affiliation(s)
- Muhuntha Sri-Ganeshan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia; and Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Vic., Australia
| | - Andrew Underhill
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Vic., Australia
| | - Claire Charteris
- Community, Integrated and Ambulatory Care, Peninsula Health, Melbourne, Vic., Australia
| | - Fergus McGee
- Emergency Department, Monash Health, Melbourne, Vic., Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia; and Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Vic., Australia
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Le LKD, Thai T, Cameron PA, Sri-Ganeshan M, O'Reilly GM, Mitra B, Nehme Z, Brichko L, Underhill A, Charteris C, Egerton-Warburton D, Mihalopoulos C. Modelled economic evaluation of a virtual emergency department in Victoria. Emerg Med Australas 2023; 35:1020-1025. [PMID: 37766421 DOI: 10.1111/1742-6723.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE Virtual ED (VED) can potentially alleviate ED overcrowding which has been a public health challenge. The aim of the present study was to conduct a return-on-investment analysis of a VED programme developed in response to changing healthcare needs in Australia. METHODS An economic model was developed based on initial patient outcome data to assess the healthcare costs, potential costs saved and return on investment (ROI) from the VED. The VED programme operating as part of Alfred Health Emergency Services. The participants were the first 188 patients accessing the Alfred Health VED. VED is the delivery of emergency assessment and management of specific patients virtually via audio-visual teleconferencing. ROI ratios that compare cost savings with intervention costs. RESULTS The mean total operational cost of VED for 79 days for 188 patients was A$344 117 (95% uncertainty interval [UI] $296 800-$392 088). The VED led to a potential A$286 779 (95% UI $241 688-$330 568) healthcare cost saving from reductions in emergency visits and A$97 569 (95% UI $74 233-$123 117) cost saving in ambulance services. The ROI ratio was estimated at 1.12 (95% UI 0.96-1.32). CONCLUSIONS The VED was cost neutral in a conservatively modelled scenario but promising if any hospital admission could be saved. Ongoing research examining a larger cohort with community follow up is required to confirm this promising result.
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Affiliation(s)
- Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thao Thai
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter A Cameron
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Muhuntha Sri-Ganeshan
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard M O'Reilly
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Lisa Brichko
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Andrew Underhill
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Claire Charteris
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Diana Egerton-Warburton
- Health Service Research Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Sri-Ganeshan M, Mitra B, Soldatos G, Howard M, Goldie N, McGee F, Nehme Z, Underhill A, O'Reilly GM, Cameron PA. Disposition of patients utilising the virtual emergency department service in southeast region of Melbourne (SERVED-1). Emerg Med Australas 2023; 35:553-559. [PMID: 36603853 DOI: 10.1111/1742-6723.14157] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Supported by the state government, three health networks partnered to initiate a virtual ED (VED), as part of a broader roll-out of emergency telehealth services in Victoria. The aim of the present study (Southeast Region Virtual Emergency Department-1 [SERVED-1]) was to report the initial 5-month experience and included all patients assessed through the service over the first 5 months (1 February 2022 to 30 June 2022). METHODS VED consults occurred after referral from paramedics in the pre-hospital setting. Electronic medical records were retrospectively reviewed for demographic, presenting complaint and outcome data. The primary outcome was the count of VED consultations. The secondary outcome was the proportion of patients where physical ED attendance was avoided within 72 h. The proportion of physical ED attendances avoided sub-grouped by primary presenting complaints were reported. RESULTS There were 1748 patients who had a VED consultation, of which 1261 (72.1%; 95% confidence interval [CI] 70.0-74.2) patients had physical presentation to an ED avoided in the 72 h following the consult. There was a significant increase in consultations over the 5-month period (incidence rate ratio 1.27; 95% CI 1.23-1.31, P < 0.001) that was consistent in the three health services. The most common presenting complaints were COVID-19 and shortness of breath, and physical presentation was avoided most often among younger patients and those with COVID-19. CONCLUSIONS Initial experience demonstrated a significant increase in adoption of the service and an overall avoidance of physical ED attendance by a majority of patients. These results support ongoing VED consultations, complemented by follow up and health economic evaluations.
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Affiliation(s)
- Muhuntha Sri-Ganeshan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Georgia Soldatos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maddi Howard
- Emergency Department, Monash Health, Melbourne, Victoria, Australia
| | - Neil Goldie
- Emergency Department, Monash Health, Melbourne, Victoria, Australia
| | - Fergus McGee
- Community, Integrated and Ambulatory Care, Peninsula Health, Melbourne, Victoria, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Underhill
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Gerard M O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
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