Queensland Health joined the bandwagon rolling out virtual emergency department models this week with the announcement that the Virtual ED service operating out of Brisbane’s Metro North HHS for the last year or so is now set to go state-wide.
Like many other hospital-based telehealth services, this one has been precipitated by the COVID pandemic and has used existing technology and existing telehealth models of care to stand up a pretty good system in a comparatively short amount of time to try to reduce long-term problems with emergency care.
Northern Health’s Victorian Virtual Emergency Department (VVED) service is probably the most prominent. It was set up with a $21 million investment using technology from Healthdirect’s Video Call system and a patient registration and intake platform from NZ firm The Clinician. It was launched initially in 2020 for local patients at the height of the pandemic, but has since expanded to include services for residential aged care facilities and ambulance services, and in June, went live statewide.
It is certainly not the first but is the most prominent. Western Australia has been providing a similar service since before the pandemic for the WA Country Health Service’s huge catchment, using emergency department clinicians based in Perth. This has in the past caused some friction, as rural GPs with admitting privileges thought they were being replaced for after-hours emergency care, but there seems to have been an understanding. WACHS continues to go from strength to strength with its service.
South Australia is expanding its virtual care service headquartered at SA Ambulance’s Tonsley Innovation District to include residential aged care facilities throughout the state to allow aged care staff to access emergency clinical advice.
NSW pioneered locally focused care virtual services during the pandemic, including initiatives like rpavirtual, but while the state has a virtual care strategy, it doesn’t appear to have any statewide services beyond its excellent stroke telehealth service, which runs on a statewide basis out of Sydney’s Prince of Wales Hospital.
The other states are catching up, and there are also a good number of primary care emergency telehealth services being run. In Australia, particularly in Victoria, My Emergency Doctor is doing great things, subsidised by quite a few PHNs. Tasmania is looking to roll out MED for secondary triage, and in New Zealand, a similar service called Emergency Consult is expanding, taking in emergency calls from residential aged care facilities and rural health services as well as ambulance and patients.
It all sounds great, not just to relieve pressure on EDs and GPs but as part of moves to use existing technology to improve care delivery. The old cliché does need to be rolled out as well, however: the proof of the pudding is in the eating and these initiatives all need to be judged based on evidence and results, not just good will and hype.
We wish them well, however. We’ve been reporting on hospital-based telehealth services and the immense struggle these have faced in getting off the ground for nigh on 15 years now. It’s marvellous to see telehealth being taken seriously and, equally importantly, being invested in, but questions do remain as to their viability and efficacy. The Australian Telehealth Society will be peering into that next week at its annual Successes and Failures in Telehealth conference in Brisbane. Might be worth going if you’re in the neighbourhood.
That brings us to our poll question for this week:
Are the new virtual emergency department models worth the investment?
Vote here or leave your comments below.
Last week we asked: Are the new virtual emergency department models worth the investment?
Most thought they were a good idea: 73 per cent said yes, while 27 per cent said no.
We also asked whether you thought they could be considered a bandaid covering systematic problems in the healthcare system. Here’s what you said:
– This is diverting money away from already underfunded and underesourced rural and remote hospitals that need doctors on the ground. Often a patient is ‘seen’ virtually then referred to their already underesourced nearest UCC or ED for review and treatment. We need to get doctors back into rural communities. It is not acceptable to say that telehealth will fix this problem. While Telehealth is an important part of healthcare it should never be used to justify downgrading or underfunding of local services.
– Isolated rural hospitals will never support a specialist team, and most rural docs are very skilled in primary resuscitation, but would be hugely helped by immediate advice.
– Virtual ED provides little value add – a well designed algorithmic advice service is as effective. These models are sheltered workshops for emergency physicians who can’t be arsed seeing patients. I’d tell you how I really feel but I’m too polite to insert it into a text field.
– If the model is integrated and links back to the primary care sector. Must avoid the ED presentation. All depends on what KPIs are measured and how.
– Healthcare needs to be done differently. Allowing people to get quality care in their own home/environment where possible is a huge step forward
– Immense benefits can arise from triage alone, both for patients and providers. Greater guidance on safety and use cases needs specific to telehealth needs to be developed by the respective professions
– No. They are part of the new landscape of care, bringing care to consumers and preventing both unnecessary ED visits and the harm that can be associated with those.
– Virtual ED helps as we are currently experiencing a shortage of GPs in our area. Alleviates need to sit hours in an ED waiting area. great initiative
– No – a virtual triage model can keep people who don’t need to be in the emergency system in their homes, however it is not enough on its own. The chronic underinvestment in primary care needs to be addressed.
– I think they are worth it as we start to change the systems. It is the first step as it identifies where some issues are and starts the push to fix them.
– Not just a band aid. for anyone who has experienced the long waits in the ED waiting room, can understand the pain of going to the ED in person. Absolutely, virtual ED is the way forward.
– Low value care for those that need an ed with huge cost to the system and for those patients that get high value – they likely never needed an expensive emergency physician that links poorly to community models/services/clinicians that would have likely better served them at less cost to the system.