What is a virtual emergency department? And when do you have to ‘visit’ one?

For many Australians the emergency department (ED) is the physical and emblematic front door to accessing urgent health-care services.

But health-care services are evolving rapidly to satisfy 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 HEALTHand bulk-billed telehealth services, which have helped hundreds of thousands of Australians to access health care on demand and from home.

The ED is similarly expanding into latest telehealth models to enhance access to emergency medical care. Virtual EDs allow people to access the expertise of a hospital ED through their phone, computer or tablet.

All Australian states and the Northern Territory have some type of virtual ED no less than in development, although not all of those services can be found to most people at this stage.

So what’s a virtual ED, and when is it appropriate to think about using one?

How does a virtual ED work?

A virtual ED is about as much as mirror the best way you’ll enter the physical ED front door. First you provide some basic information to administration staff, you then are triaged by a nurse (this implies they categorise the extent of urgency of your case), you then see the ED doctor. Generally, this all takes place in a single video call.

In some instances, virtual ED clinicians may seek the advice of with other specialists comparable to neurologists, cardiologists or trauma experts to make clinical decisions.

A virtual ED is just not suitable for managing medical emergencies which might require immediate resuscitation, or potentially serious chest pains, difficulty respiration or severe injuries.

A virtual ED is best suited to conditions that require immediate attention but are usually not life-threatening. These could include wounds, sprains, respiratory illnesses, allergic reactions, rashes, bites, pain, infections, minor burns, children with fevers, gastroenteritis, vertigo, hypertension, and lots of more.

People with these types of conditions and concerns may not give you the option to get in to see a GP right away and should feel they need emergency advice, care or treatment.

When attending the ED, they might be subject to long wait times and delayed specialist attention because more serious cases are naturally prioritised. Attending a virtual ED may mean they’re seen by a health care provider more quickly, and might begin any relevant treatment sooner.

From the angle of the health-care system, virtual EDs are about redirecting unnecessary presentations away from physical EDs, helping them be ready to answer emergencies. The virtual ED won’t hesitate in directing callers to come back into the physical ED if staff imagine it’s an emergency.

The doctor within the virtual ED may direct the patient to a GP or other health skilled, for instance if their condition can’t be assessed visually, or in the event that they need physical treatment.

The results up to now

Virtual EDs have developed significantly over the past three years, predominantly driven by the COVID pandemic. We are actually beginning to slowly see assessments of those services.

A recent evaluation my colleagues and I did of Queensland’s Metro North Virtual ED found roughly 30% of calls were directed to the physical ED. This suggests 70% of the time, cases might be managed effectively by the virtual ED.

Preliminary data from a Victorian virtual ED indicates it curbed the same rate of avoidable ED presentations – 72% of patients were successfully managed by the virtual ED alone. A study on the cost-effectiveness of one other Victorian virtual ED suggested it has the potential to generate savings in health-care costs if it prevents physical ED visits.

Only 1.2% of individuals assessed in Queensland’s Metro North Virtual ED required unexpected hospital admission inside 48 hours of being “discharged” from the virtual ED. None of those cases were life-threatening. This indicates the virtual ED may be very protected.

The service experienced an average growth rate of 65% every month over a two-year evaluation period, highlighting increasing demand and confidence within the service. Surveys suggested clinicians also view the virtual ED positively.

What now?

We need further research into patient outcomes and satisfaction, in addition to the demographics of those using virtual EDs, and the way these measures compare to the physical ED across different triage categories.

There are also challenges related to virtual EDs, including around technology (connection and skills amongst patients and health professionals), training (for health professionals) and the importance of maintaining security and privacy.

Nonetheless, these services have the potential to scale back congestion in physical EDs, and offer greater convenience for patients.

Eligibility differs between different programs, so if you would like to use a virtual ED, you might need to ascertain you’re eligible in your jurisdiction. Most virtual EDs might be accessed onlineand a few have direct phone numbers.