Evaluation of a virtual emergency care service to avoid unnecessary emergency department presentations and provide specialist-led definitive care

Abstract

Objective: A quantitative and qualitative evaluation of the impact of a peer-to-peer telehealth service called Specialist Telehealth Aotearoa (STAR) on transfers to the ED.

Methods: This mixed-methods study reviewed STAR between 31 July 2023 and 31 October 2023. Reasons for presentation and outcomes were analysed. Thematic analysis was used to examine responses to an electronic survey from referrers to the STAR service, exploring the benefits and barriers to engagement with the service.

Results: Eight hundred and sixty-seven consultations occurred, with hospital transfer avoided for 500 (58%) patients. Fifty-one patients (10.2%) re-presented to Christchurch Hospital within 7 days with the same/related issue, similar to the overall hospital 7-day re-presentation rate of 9.5%. Survey responses were received from 130 ambulance staff and rural practitioners, with 97% reporting a 'very good' or 'excellent' experience with STAR. Thematic analysis of responses from referrers identified four main benefits: local FACEMs who understand the local context, mutual trust built on pre-existing relationships, empowering pre-hospital and rural clinicians and putting the patient first: providing right care-right place-right time.

Conclusions: STAR prevented unnecessary transfers to ED with a 7-day representation rate comparable to the wider hospital. Referrers reported a number of benefits to the service, as well as identifying potential barriers to engagement. The integration of a specialist emergency care telehealth service into the health system could alleviate pressure on EDs in Aotearoa New Zealand.

Keywords: digital health; emergency department; patient flow; telehealth; triage.

Figure 1

Patient destinations.