Virtual ED: The effect of telehealth on emergency department (ED) attendances

The Virtual ED was instigated at the Alfred, Peninsula and Monash Health Networks and will run for the foreseeable future, as standard care for patients seeking emergency care and planned by Ambulance Victoria to be transported to one of the relevant Emergency Departments. The model the virtual ED is as follows: paramedics will attend patients who call an ambulance, where they will make a decision regarding the patient’s eligibility to participate in the virtual ED program. If the patient is eligible to participate, the ambulance will call the virtual ED consultant between 12pm-10pm. They are initially seen by a ward clerk to record patient demographics and be given an MRN. They are then seen by the virtual ED clinician who will make a plan regarding patient’s initial management and disposition. A decision will then be made as to whether to treat remotely, or determine an alternative disposition (e.g. outpatient care, teams), or determine that they need to be seen in the ED. The project will involve local clinicians who are familiar with their respective local health system and resources available within Alfred Health and are rostered on to participate as the virtual ED consultant that day. If the patient is diverted from physically attending the ED, then a care coordinator will attempt to call the patient at 24 hours and at 7 days to follow-up with them regarding their status and outcomes. All patients utilizing the Virtual ED (VED) service during the study period will be included in the study. A waiver of consent will be sought. Data will be collected retrospectively from review of electronic medical records from 27 January 2022 until the date of ethics approval, after which prospective data will be collected until 27/01/2023, . Data obtained will pertain to patient demographics, presenting complaint, intervention provided by VED service and disposition decisions following consult. As part of routine care, patients receive a follow phone call at 1 day and 7 days post VED consultation, details of which will be recorded in the electronic medical record. From these follow up phone calls details regarding presentation to Hospital following VED consult within 72 hours and 7 days as well as progress of condition would be determined. More detailed information regarding to outcomes of patients presenting to Hospital will obtained from review of the electronic medical records for patient who present within one of the participant Hospital networks.