From patients to rural GPs and bush nurses, Victoria’s innovative service has been fully embraced.
The Victorian Virtual Emergency Department has marked a major milestone in its short history, notching up its 100,000th patient.
The department has gone from strength to strength since it began in October 2020 as a pilot project at Northern Hospital Epping to help patients in the north with covid symptoms, relieve pressure on emergency waiting rooms, and treat more people from the comfort of their home.
In less than three years the program has been rolled out to patients across Victoria, making it the first service of its kind in Australia.
Dr Suzie Miller is an emergency physician and clinical deputy director of the VVED, as well as its director of strategy, quality and technology.
She can see a big future for this model – even a major place for it in a national healthcare strategy.
“We have really good working relationships with the other states. In fact, I’m part of a benchmarking initiative that’s been run by Tim Schultz out of Flinders University in South Australia, where we sat down with the other states and said, ‘What are we going to use to decide if we’re giving good quality care? How are we going to benchmark this?’,” Dr Miller told The Medical Republic.
“There’s a lot of collaboration between states, for example, we know RPA virtual is up and running, we meet with them regularly. Queensland, South Australia, Western Australia, and now New Zealand are involved in the mix. The only way forward for us, as a country, is going to be collaborative models between states.
“There’s no need to reinvent the wheel, I think we can learn from each other. And my hope is that every Australian eventually has access to a service as safe, effective and high-quality care that the virtual ED in Victoria provides.”
The VVED triages and treats patients with non-life-threatening conditions virtually, and is available 24 hours a day, seven days a week. This service is the first of its kind in Australia.
Patients can connect to the service from any personal device with a camera and do not require a referral to access the virtual care provided by emergency doctors and nurses. They can also be connected to the VVED through their GP, Ambulance Victoria, or other health professionals.
The VVED also has works with hospitals around the state, residential aged care facilities and Primary Health Networks (PHNs) to ensure better access to virtual emergency care.
The doctors and nurses who staff the service work from Northern Health’s offices or from home.
Dr Miller said they 100,000 patient mark had come and gone – “we’re seeing easily 400 patients a day now”.
“They are coming from all over. We are now a statewide service and that means we’re seeing everyone in every part of the state,” she said.
“One thing we’re particularly proud of is even though we have made great inroads in the metro areas, one of the best things we’ve done is made sure that regional and rural Victorians know we exist.
“We’re all very proud of the fact that we can give this extra service to people who often don’t have great access to care.”
One of the big concerns to become apparent during the past couple of years has been access to primary care, in particular GPs. Dr Miller said she often heard about the difficulty patients had in getting appointments with their GPs.
“It’s a big concern to me that they don’t have any access to primary care, because we all know, the most important doctor in your life is your primary care doctor, and these people need access to that,” she said.
“What we’re trying to do is make sure the right person is getting the right care in the right place at the right time.
“Because they often don’t need the ED, they just need something in between. And we are able to provide not only ED in your home, but God forbid you do need to get in-person care, we can get you to the right place.”
The VVED has strong partnerships with Victoria’s network of PHNs. In fact, Dr Miller said, “we couldn’t do this without them”. And while the VVED has built its own network of information sharing, it has highlighted the need for a cohesive, integrated, national source of information that can be used by both patients and the health professionals caring for them – no matter where they are.
“What I have seen here is the importance of having one place for patients to call to ask questions about acute care,” she said.
“Can you imagine if it was not just Victoria-wide but Australia-wide, and every patient knew that one number to call to say, I’m not quite sure what to do? Do I go to the ED? Do I go to my GP? Do I go to an urgent care centre? Do I go to a PPCC [priority primary care centre]? Can you treat me on the line right now?
“And that is possible, we’re proving that’s possible. We should, I believe, have that one universal place where everyone’s collaborating to get this care to all Victorians or perhaps all Australians.”
One of the big successes of this model has been its impact on residents of aged care facilities. Dr Miller said the data was very, very clear that most of the time for elderly patients being sent to a busy, busy emergency department with high infectious disease risk, and then also admitted to the hospital, dramatically increased their chance of delirium, falls and poor outcomes.
“Of course, if it’s appropriate for the patient to get care in a hospital, we will always send them,” she said.
“But what I have found, and this is a lot of what I do now, is I talked to everybody. I talked to the patient, I talked to the nurse, I talked to the family, I sometimes talk to the GP, I talked to the residential entry services, and I’m able to coordinate the care for that patient.
“And I can tell you that at least 90% of the time, probably more in my own practice, I am able to safely leave that patient in the facility to receive treatment, and they get really good treatment. And they and the families are thrilled by this. Because no one wants to send their 95-year-old dad with dementia to the hospital if they don’t have to. And now we have a way to solve that.”
Dr Miller said the reaction from GPs had been mostly positive, and although there were still some doctors who needed to be reached through education, others had embraced the model and used it as their “waiting room control”.
“We have GPS, who have patients walk into their clinic and there’s no appointments available, and the GP says, ‘Can you please call the virtual ED and let us know what they say’,” she said.
“We have some GPs who are actually using us as their waiting room control because they can’t see everyone they need to see. And they know that we’re going to give really high-quality care.”
Rural and regional GPs and even bush nurses have taken it one step further, calling into the VVED with their patients to speak to specialists who are also on call.
“I’m always amazed by their skill sets, I think the regional and rural practitioners are basically our most talented people in the healthcare space,” Dr Miller said.
One of the biggest differences between the VVED and traditional EDs is the wait time.
“Our wait times last month were an average of seven minutes,” Dr Miller said.
“Now, I can’t promise that forever. In the last four months, it’s been an average of seven to eight minutes. But even if we keep these to less than 15 to 20 minutes, that is an extraordinarily fast amount of time to get the information you require. And we’re so proud of that.”
