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墨尔本东南部(SERVED-1)虚拟急诊部服务利用患者处置情况。

Disposition of patients utilising the virtual emergency department service in southeast region of Melbourne (SERVED-1).

机构信息

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia.

出版信息

Emerg Med Australas. 2023 Aug;35(4):553-559. doi: 10.1111/1742-6723.14157. Epub 2023 Jan 5.

DOI:10.1111/1742-6723.14157
PMID:36603853
Abstract

OBJECTIVE

Supported by the state government, three health networks partnered to initiate a virtual ED (VED), as part of a broader roll-out of emergency telehealth services in Victoria. The aim of the present study (Southeast Region Virtual Emergency Department-1 [SERVED-1]) was to report the initial 5-month experience and included all patients assessed through the service over the first 5 months (1 February 2022 to 30 June 2022).

METHODS

VED consults occurred after referral from paramedics in the pre-hospital setting. Electronic medical records were retrospectively reviewed for demographic, presenting complaint and outcome data. The primary outcome was the count of VED consultations. The secondary outcome was the proportion of patients where physical ED attendance was avoided within 72 h. The proportion of physical ED attendances avoided sub-grouped by primary presenting complaints were reported.

RESULTS

There were 1748 patients who had a VED consultation, of which 1261 (72.1%; 95% confidence interval [CI] 70.0-74.2) patients had physical presentation to an ED avoided in the 72 h following the consult. There was a significant increase in consultations over the 5-month period (incidence rate ratio 1.27; 95% CI 1.23-1.31, P < 0.001) that was consistent in the three health services. The most common presenting complaints were COVID-19 and shortness of breath, and physical presentation was avoided most often among younger patients and those with COVID-19.

CONCLUSIONS

Initial experience demonstrated a significant increase in adoption of the service and an overall avoidance of physical ED attendance by a majority of patients. These results support ongoing VED consultations, complemented by follow up and health economic evaluations.

摘要

目的

在州政府的支持下,三个医疗网络合作启动了虚拟急症室(VED),作为维多利亚州更广泛推出远程急症服务的一部分。本研究(东南地区虚拟急症部-1 [SERVED-1])的目的是报告最初的 5 个月经验,包括该服务头 5 个月(2022 年 2 月 1 日至 6 月 30 日)评估的所有患者。

方法

VED 会诊是在院前由护理人员转介后进行的。对电子病历进行回顾性分析,以获取人口统计学、就诊主诉和结局数据。主要结局是 VED 会诊的次数。次要结局是在 72 小时内避免实体急症室就诊的患者比例。报告了按主要就诊主诉分类的避免实体急症室就诊的比例。

结果

有 1748 名患者进行了 VED 会诊,其中 1261 名(72.1%;95%置信区间 [CI] 70.0-74.2)患者在会诊后 72 小时内避免了实体急症室就诊。在 5 个月期间,会诊数量显著增加(发病率比 1.27;95%CI 1.23-1.31,P<0.001),在三个医疗服务机构中一致。最常见的就诊主诉是 COVID-19 和呼吸急促,COVID-19 患者和年轻患者最常避免实体急症室就诊。

结论

初步经验表明,该服务的采用率显著增加,大多数患者总体上避免了实体急症室就诊。这些结果支持持续进行 VED 会诊,并结合后续和健康经济评估。

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