QUEENSLAND VIRTUAL ED: A SERVICE OVERVIEW

Introduction: Queensland’s first Virtual Emergency Department began as an initiative of one Brisbane-based public health service in early 2020, with the goal of supporting GPs and other outpatient clinicians to avoid referrals to physical EDs.

Purpose: While continuing to support external clinicians with complex clinical decisions, Virtual ED staff recognised that most presentations to physical EDs are patients’ own decisions, not GP referrals. Virtual ED pivoted to additional provision of direct patient care through self-referral and extended to a statewide service.

Activity: Virtual ED added a patient-facing portal in April 2022 and self-referrals quickly outpaced all other sources, now totalling 65% of presentations. Patients enter the telehealth portal and are assessed by an experienced triage nurse before being seen by an ED consultant. Treatment may include advice, prescriptions, or referral to specialty services. Patients wait an average of 15 minutes between triage and consultation.

Outcome: Over the last six months, our data show that about 75% of patients are treated and remain at home, while 5% remain under GP care or are referred to outpatient services. 15% are sent for review in an ED, equating to more than 6000 patients avoiding a hospital ED presentation. Patient satisfaction with Virtual ED is extremely high, with 90% reporting that the service was outstanding.

Conclusion: Queensland Health’s Virtual Acute Care Service has been proven a success. Virtual ED plans to expand both hours of service and its range of clinicians to support the service.

Introduction

Patients with mild-moderate trauma have reduced health-related quality of life and poor rates of return to work. Locally, this patient population has no specific follow-up service. In 2022, RPA Virtual Hospital (rpavirtual) collaborated with the Royal Prince Alfred Hospital (RPAH) Trauma Service to develop an innovative model of care to provide and coordinate follow-up care for patients with minor-moderate trauma.

Target population

The rpavirtual Trauma Clinic (vTC) aims to coordinate and optimise patients’ trauma care post-discharge. vTC aims to improve trauma patient outcomes relating to function and mental health and help prevent complications related to their injuries, prevent unnecessary hospital admissions, re-presentations to the emergency department and reduce length of stay (LOS).

Intervention

vTC is a multidisciplinary follow-up service for minor to moderate trauma patients, led by a Trauma Clinical Nurse Consultant (CNC) with support from an rpavirtual Emergency Physician.

Results

Initial analysis of the first 50 patients showed hospital LOS for admitted patients reduced by 1.3 days on average, ED LOS for non- admitted patients reduced by two hours on average and admission rates reduced by 30 percent. The projected savings annually encompassed 137 bed days saved and approximately $265,958 cost avoidance.

Patient feedback revealed 91.6 percent of patients rated their care as “excellent” or “good”. 83.3 percent of patients reported the virtual care appointment as helpful/beneficial and vTC made it easier to get treatment.

Key Learnings

Virtual follow-up care for patients with minor-moderate trauma is beneficial for patients’ physical and psychological health and for health care systems.

Introduction:
The Virtual Nurse Assist and Midwifery Care (vNAMC) model addresses the challenges faced by healthcare professionals working in rural facilities in Far West New South Wales.
Aim:
By leveraging telehealth and virtual technology, vNAMC aims to provide nursing support and midwifery care to rural nurses and women in identified areas of need. This model builds on the successful collaboration between Sydney and Far West Local Health Districts (SLHD and FWLHD), with a focus on improving access to healthcare.
Methods:
To establish a strong foundation for vNAMC, SLHD and FWLHD stakeholders engaged in clinical discussions and data analysis, identifying the priority areas for nursing and midwifery support in the Far West region. Multiple site visits and collaborative planning meetings fostered strong collegial relationships and a shared dedication to delivering exceptional care to patients in remote areas.
Results:
Since launch in May 2023, vNAMC has demonstrated promising outcomes, including improved patient outcomes and enhanced continuity of care for women in remote areas, with expectations of further growth. Ongoing efforts focus on expanding the model through education and training of nursing staff in remote areas, as well as conducting research on the impact of vNAMC on staff and patients, staff retention, and staff satisfaction.
Conclusion:
The vNAMC model of care has great potential to address healthcare disparities, to improve the delivery of quality care in rural settings. By leveraging telehealth and virtual technology, this model bridges gaps caused by resource limitations and geography, ensuring equitable access to healthcare irrespective of physical distance.

Background/Introduction:
Obtaining informed consent for research in the Emergency Department (ED) can be challenging due to the complex nature of traditional paper-based consent forms. eConsent has emerged as a potential solution, offering various benefits such as improved accessibility, infection control, and integration with digital research platforms. We will explore the use of eConsent as a patient-oriented approach and its potential impact on the consent process for ED research.

Methods/Intervention/Activity:
The INFORMED sepsis study is an RCT, which incorporates eConsent and sepsis education at the bedside. One group receives study information and consent forms in paper format, the other group receives them electronically. The participants' comprehension and recall of study information are assessed through a 10-question multi-choice quiz, and their consent experience is evaluated through an open-ended question.

Results/Outcome:
Enrolment has begun in the ED, and the outcomes of the study are expected in 2024. The use of eConsent facilitated by the REDCap platform.

Conclusion/Recommendations:
The adoption of eConsent in the ED research setting holds promise for enhancing the consent process. By leveraging digital technologies and providing accessible formats for study information, eConsent can address the challenges associated with traditional paper-based consent forms. Further research and implementation of eConsent in emergency nursing research are recommended to optimize the consent process and improve patient participation and understanding.