A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia
Abstract Background Provision of critical care in rural areas is challenging due to geographic distance, smaller facilities, generalist skill mix and population characteristics. Internationally, the amalgamation telemedicine and retrieval medicine services are developing to overcome these challenges...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-023-10425-7 |
| _version_ | 1797350038406430720 |
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| author | Kimberley Dean Cynthia Chang Erin McKenna Shannon Nott Amanda Hunter Julie A. Tall Madeline Setterfield Bridget Addis Emma Webster |
| author_facet | Kimberley Dean Cynthia Chang Erin McKenna Shannon Nott Amanda Hunter Julie A. Tall Madeline Setterfield Bridget Addis Emma Webster |
| author_sort | Kimberley Dean |
| collection | DOAJ |
| description | Abstract Background Provision of critical care in rural areas is challenging due to geographic distance, smaller facilities, generalist skill mix and population characteristics. Internationally, the amalgamation telemedicine and retrieval medicine services are developing to overcome these challenges. Virtual emergency clinical advisory and transfer service (vCare) is one of these novel services based in New South Wales, Australia. We aim to describe patient encounters with vCare from call initiation at the referring site to definitive care at the accepting site. Methods This retrospective observational study reviewed all patients using vCare in rural and remote Australia for clinical advice and/or inter-hospital transfer for higher level of care between February and March 2021. Data were extracted from electronic medical records and included remoteness of sites, presenting complaint, triage category, camera use, patient characteristics, transfer information, escalation of therapeutic intervention and outcomes. Data were summarised using cross tabulation. Results 1,678 critical care patients were supported by vCare, with children (12.5%), adults (50.6%) and older people (36.9%) evenly split between sexes. Clinicians mainly referred to vCare for trauma (15.1%), cardiac (16.1%) and gastroenterological (14.8%) presentations. A referral to vCare led to an escalation of invasive intervention, skill, and resources for patient care. vCare cameras were used in 19.8% of cases. Overall, 70.5% (n = 1,139) of patients required transfer. Of those, 95.1% were transferred to major regional hospitals and 11.7% required secondary transfer to higher acuity hospitals. Of high-urgency referrals, 42.6% did not receive high priority transport. Imaging most requested included CT and MRI scans (37.2%). Admissions were for physician (33.1%) and surgical care (23.3%). The survival rate was 98.6%. Conclusion vCare was used by staff in rural and remote facilities to support decision making and care of patients in a critical condition. Issues were identified including low utilisation of equipment, heavy reliance on regional sites and high rates of secondary transfer. However, these models are addressing a key gap in the health workforce and supporting rural and remote communities to receive care. |
| first_indexed | 2024-03-08T12:39:03Z |
| format | Article |
| id | doaj.art-0f68c43933e34d84a0889feae833adbd |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-03-08T12:39:03Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-0f68c43933e34d84a0889feae833adbd2024-01-21T12:15:20ZengBMCBMC Health Services Research1472-69632024-01-0124111310.1186/s12913-023-10425-7A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote AustraliaKimberley Dean0Cynthia Chang1Erin McKenna2Shannon Nott3Amanda Hunter4Julie A. Tall5Madeline Setterfield6Bridget Addis7Emma Webster8Orange Health Service, Western NSW Local Health District Maitland Hospital, Hunter New England Local Health DistrictSchool of Rural Health, Faculty of Medicine and Health, University of SydneySchool of Rural Health, Faculty of Medicine and Health, University of SydneyvCare Western NSW Local Health DistrictHealth Intelligence Unit, Western NSW Local Health DistrictSchool of Rural Health, Faculty of Medicine and Health, University of SydneySchool of Rural Health, Faculty of Medicine and Health, University of SydneySchool of Rural Health, Faculty of Medicine and Health, University of SydneyAbstract Background Provision of critical care in rural areas is challenging due to geographic distance, smaller facilities, generalist skill mix and population characteristics. Internationally, the amalgamation telemedicine and retrieval medicine services are developing to overcome these challenges. Virtual emergency clinical advisory and transfer service (vCare) is one of these novel services based in New South Wales, Australia. We aim to describe patient encounters with vCare from call initiation at the referring site to definitive care at the accepting site. Methods This retrospective observational study reviewed all patients using vCare in rural and remote Australia for clinical advice and/or inter-hospital transfer for higher level of care between February and March 2021. Data were extracted from electronic medical records and included remoteness of sites, presenting complaint, triage category, camera use, patient characteristics, transfer information, escalation of therapeutic intervention and outcomes. Data were summarised using cross tabulation. Results 1,678 critical care patients were supported by vCare, with children (12.5%), adults (50.6%) and older people (36.9%) evenly split between sexes. Clinicians mainly referred to vCare for trauma (15.1%), cardiac (16.1%) and gastroenterological (14.8%) presentations. A referral to vCare led to an escalation of invasive intervention, skill, and resources for patient care. vCare cameras were used in 19.8% of cases. Overall, 70.5% (n = 1,139) of patients required transfer. Of those, 95.1% were transferred to major regional hospitals and 11.7% required secondary transfer to higher acuity hospitals. Of high-urgency referrals, 42.6% did not receive high priority transport. Imaging most requested included CT and MRI scans (37.2%). Admissions were for physician (33.1%) and surgical care (23.3%). The survival rate was 98.6%. Conclusion vCare was used by staff in rural and remote facilities to support decision making and care of patients in a critical condition. Issues were identified including low utilisation of equipment, heavy reliance on regional sites and high rates of secondary transfer. However, these models are addressing a key gap in the health workforce and supporting rural and remote communities to receive care.https://doi.org/10.1186/s12913-023-10425-7Emergency careRetrieval medicineRural and remote healthcareTelehealthTransfer medicineVirtual medicine |
| spellingShingle | Kimberley Dean Cynthia Chang Erin McKenna Shannon Nott Amanda Hunter Julie A. Tall Madeline Setterfield Bridget Addis Emma Webster A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia BMC Health Services Research Emergency care Retrieval medicine Rural and remote healthcare Telehealth Transfer medicine Virtual medicine |
| title | A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia |
| title_full | A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia |
| title_fullStr | A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia |
| title_full_unstemmed | A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia |
| title_short | A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia |
| title_sort | retrospective observational study of vcare a virtual emergency clinical advisory and transfer service in rural and remote australia |
| topic | Emergency care Retrieval medicine Rural and remote healthcare Telehealth Transfer medicine Virtual medicine |
| url | https://doi.org/10.1186/s12913-023-10425-7 |
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