Step inside the virtual emergency department

4 minute read

But not literally, because it’s online.

The Victorian government’s five new urgent care clinics won’t be without competition: telehealth is already helping deliver care to the too-urgent-for-a-GP-but-not-sick-enough-for-a-hospital patient cohort in the state.

Victorian Premier Daniel Andrews announced this week that over the coming months, GP-led clinics will be established close to five major emergency departments in the state.

The proposed clinics aim to decrease demand on emergency departments and will operate 16 hours per day, every day.

There’s no question that Victorian EDs are in need of relief, with presentation numbers hitting record highs over the last quarter.

But given the lukewarm reception among GPs for Health Minister Mark Butler’s urgent care centres plan, it’s worth mentioning that successful ED alternatives are already operating in the area.

Virtual emergency departments staffed by a mixture of GP and emergency medicine fellows have cropped up across the country over the course of the pandemic.

Northern Health, which operates two public hospitals on Melbourne’s outskirts, has run a statewide virtual ED since late 2020 and recently received additional state funding to double its capacity and expand into residential aged care.

One of the hospitals operated by Northern Health, Northern Hospital Epping, was also named as one of the sites for the GP-led urgent care clinic.

The service operates around the clock, offering video consults with a doctor or nurse for Victorians with non life-threatening conditions, generally within a half-hour.

GPs make up about 40% of the clinicians on the team at the Victorian Virtual ED.

Dr Loren Sher, clinical director of the VVED, told The Medical Republic that most of the GPs working at the service do so in addition to their regular community-based practice.

The VVED may be the best known virtual ED, but it’s far from the only one.

Sydney-based emergency physician Dr Sue Ieraci has found job satisfaction working in a virtual ED that services the whole country.

“One of the things that frustrated me about hospitals is that big organisations tend to be trying to minimise the risk for the institution, as opposed to the patient,” she told TMR.

“Whereas what I’m doing when I’m one-to-one with the patient is just coming up with a plan that they’re happy with and addressing their needs, rather than having any institution worried about its own risk.”

For Dr Ieraci, working virtually “eliminated” many of the frustrations she felt working in a hospital, while still allowing her to use her emergency medicine training.

The clinical load a virtual emergency physician like Dr Ieraci takes on runs the gamut from acute injury to the administrative side of doctoring.

“It can be as bad as a resuscitation, where we’re helping the on-site staff, at one end of the spectrum,” she said.

In the less dramatic case of, say, a broken bone, then “if it’s a nurse-led small hospital or in the community, we can supply the request for imaging”.

Sometimes the work can just be confirming the best course of action with hospital staff.

“Often the nurses have a good handle on what needs to be done, but they need backup to access care for their patients or need to be reassured that they do not have to seek transfer,” Dr Ieraci said.

Then there are the acute “almost limitless” non life-threatining emergencies – calls from the worried parents of a child with fever or people worried about their blood pressure.

“We can go into nursing homes with video and see patients there with their different concerns,” Dr Ieraci said.

For elderly patients who are frail or have dementia, a hospital is arguably the worst place to be.

“The greatest benefit [of a virtual ED] is preventing people having to go to a physical ED or leave their home to access care,” she said.

It looks a lot like general practice, just done in a shorter timeframe – not dissimilar to Labor’s urgent care clinic proposal.

“The difference in the service that I work for, [as opposed to the urgent care clinics] is that it’s staffed only by specialist emergency physicians,” said Dr Ieraci.

“We’ve got particular skills and we’re able to assess and manage people at that sharp end of the urgency and severity scale, as well as sometimes at the lower end.”

Dr Ieraci stressed that virtual EDs weren’t there to take the place of a GP; just to fill the gap created by overcrowded services.

“We’re always conscious of the fact that we’re just providing episodic care,” she said.

“We’re not providing general practice in that we’re not doing long term prevention or family medicine, we’re just reacting to acute needs for help.”

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