The effectiveness of the Diversion of Patients from an Emergency Department Waiting Room to a Virtual Medical Consultation

The increase in number of presentations to Emergency Departments (EDs) has continued to contribute to poor health outcomes worldwide. The diversion of suitable patients from the waiting room to receive a virtual medical consultation potentially addresses this problem. This retrospective study was undertaken at a metropolitan ED utilizing the public state-wide Victorian Virtual Emergency Department (VVED) service. Nonurgent patients were identified and offered services in a soundproof room adjacent to the waiting room. The proportions of successful diversions from the physical ED and subsequent presentations in the following seven days were reported. A review of all representations to the hospital was undertaken via a modified Institute of Healthcare Improvement framework. A total of 339 patients were treated via this pathway, resulting in 258(76%) of patients being diverted from the ED. Eighty-one(24%) participants were advised to visit the ED as planned. A total of 206 participants(61%) had no further contact with the VVED or the ED. A total of 20(6%) patients undertook a subsequent VVED consultation, and 30(9%) presented to the ED in less than seven days and two were directly admitted to a short-stay unit. Twelve patients had hospital admissions of less than seven days, and no deaths were reported. In the case reviews, three patients were identified as having an adverse event resulting in temporary harm. Virtual consultation services can be integrated into the ED waiting room, resulting in the successful diversion of patients with a small number of adverse events.