Workforce shortages are now commonplace across all regional NSW Local Health Districts. With the provision of an Emergency Department (ED) service necessitates that the sole Registered Nurse in-charge of the facility is also competent and confident in ED nursing, which includes understanding triage and other ED models of care.
During a period of significant staff shortages, Bourke Hospital in Western NSW was unable to provide appropriately trained ED nurses. With well established virtual services already in place, Western NSW was well positioned to solve this issue by adopting a virtual solution. With no existing precedent or governance in place to guide this pilot, a risk register was developed based on assumptions of potential occurrences during the pilot phase.
Over 87 days there were 49 calls for virtual triage. The majority of calls were for patients who met Australian Triage Scale 3 or 4 criteria.
Three positives were identified from the pilot: close working relationships were developed with the nurses on site, the ED was able to remain open during those 87 days, and deployed staff were grateful for the support option being provided.
The limitations identified included delay to assessment time from registration to triage, difficulties conducting triage with patients exhibiting neurodivergence, aggressive or agitated behaviours, fluctuating ability of staff to conduct hands on assessments to help inform triage and the inability of the virtual nurse to manage complex situations such as multiple simultaneous presentations.
Whilst the experiences in WNSWLHD were limited to the 87-day pilot, the lessons learned have been shared during the creation of state policy and provide several recommendations for future implementations of this concept.