Embedding a Virtual Emergency Department Pathway Within Emergency Medical Services Secondary Triage for People Living...

Patients living in residential aged care homes (RACH) frequently experience acute health episodes prompting contact with emergency medical services (EMS). To improve health care access and reduce unnecessary emergency department (ED) presentations, a referral pathway to the Victorian Virtual ED (VVED) was introduced to EMS secondary triage (comprehensive telephone-based assessment of lower acuity cases). This study evaluates the impact of the pathway on referral outcomes, ED diversion, and patient safety indicators.

A retrospective cohort study of patients living in RACH who underwent EMS secondary triage in Victoria, Australia was conducted. Data were compared between an 18-month pre-implementation period and an 18-month post-implementation period following the introduction of the referral pathway. Descriptive analyses, interrupted time-series and multivariable logistic regression were used to assess changes in referral outcomes, ED diversion, and recontact within 72 h.

A total of 59,546 secondary triage cases from RACH were included. Referrals to alternate care pathways increased from 6.8% pre-implementation to 11.2% post-implementation, largely driven by referrals to the VVED (6.7%), while ED diversion also increased (18.7% to 28.9%). Interrupted time-series analysis showed introduction of the VVED pathway was associated with an increase in referrals to alternate care pathways (IRR: 1.349 (95%CI: 1.182, 1.539)). In the post-implementation period, referral to the VVED was associated with increased age (AOR 1.12 (95%CI: 1.04,1.20), per 10 year increase), metropolitan event location (AOR 1.18 (95%CI: 1.04,1.34), compared with regional location), out-of-hours calls (AOR 1.55 (95%CI: 1.39,1.72), compared with calls between 0800 and 1700), complaints of external injury (AOR 1.50 (95%CI: 1.13, 1.98) compared with generally unwell), and lower acuity care timeframes (AOR 19.13 (95%CI: 15.01, 24.39) compared with recommendation for immediate care). Seventy-two-hour recontact to EMS increased, from 3.1% to 3.5% (p = 0.002) while lights and sirens transports to ED remained stable (2.5%).

The introduction of the VVED referral pathway to secondary triage was associated with increased use of alternate care pathways and a significant increase in ED diversion for RACH residents. Specific patient and call time characteristics were associated with VVED referral, suggesting the VVED has a targeted role in meeting access needs out of hours and for select clinical presentations.