Extending emergency care beyond discharge: Piloting a virtual after care clinic

Area of Science:

• Emergency Medicine
• Health Services Research
• Telehealth

Background:

• Unscheduled emergency department (ED) return visits are often linked to inadequate outpatient follow-up care.
• A virtual after care clinic (VACC) was piloted as an innovative solution for patients discharged from the ED.

Purpose of the Study:

• To evaluate the effectiveness of an emergency medicine-staffed, on-demand VACC in reducing ED return visits.
• To compare the risk of ED return at 72 hours and 30 days for patients who attended VACC appointments versus those who did not.

Main Methods:

• A prospective cohort study was conducted involving patients discharged from the ED who scheduled VACC appointments within 72 hours.
• Descriptive analyses were performed, and the risk of ED return at 72 hours and 30 days was compared between VACC attendees and no-shows.

Main Results:

• Out of 309 patients who scheduled VACC appointments, 210 (68%) attended. Attendees were less likely to return to the ED within 72 hours (3.3% vs. 13.1%) and 30 days (16.2% vs. 30.3%) compared to no-shows.
• VACC attendance was significantly associated with lower odds of 72-hour and 30-day return ED visits.

Conclusions:

• The pilot study demonstrated that VACC appointments were preferentially scheduled by younger, white, female, commercially insured patients with a primary care physician.
• Attending a VACC appointment was associated with a reduced likelihood of returning to the ED within 72 hours and 30 days.