Outcomes of a state-wide virtual emergency department in Victoria, Australia: a linked data analysis of emergency department utilisation and hospital use.

BACKGROUND

The Victorian Virtual Emergency Department (VVED) is a synchronous video-based emergency care service established to reduce the burden on physical EDs by managing patients remotely. Despite rapid growth in virtual emergency care models, evidence regarding downstream hospital utilisation and factors associated with subsequent ED presentation remains limited. We aimed to examine downstream ED utilisation following a VVED consultation and identify factors associated with unplanned ED presentation.

METHODS

We conducted a retrospective cohort study using linked statewide administrative data. The study included all patients registered with the VVED between 1 July 2022 and 23 June 2023. The primary outcome was unplanned ED presentation within 48 h among patients initially managed in the community. Secondary outcomes included discharge destination and planned and unplanned ED utilisation within 48 h and 7 days. Mixed-effects logistic regression was used to identify factors associated with unplanned ED presentation.

FINDINGS: Of 100,422 VVED presentations, 75.5% (n = 75,871) were managed at home and 15.3% (n = 15,353) were referred to a physical ED. Among patients managed at home, 8.2% (n = 6202) attended a physical ED within 48 h, increasing to 11.4% (n = 8667) within 7 days. Overall, 81.5% (n = 81,840) of patients did not attend a physical ED within 48 h. Primary diagnosis category was the only factor independently associated with unplanned ED presentation within 48 h.

INTERPRETATION: Most patients were managed in the community, with low unplanned ED utilisation. Higher unplanned rates in our Healthcare Professional pathway likely reflect greater clinical complexity. Further research is needed to explore long-term outcomes, patient perspectives, optimal referral pathways for high-risk groups and the temporal and causal relationship between VVED implementation and physical ED utilisation.

FUNDING: This study was conducted as part of a Digital Health Cooperative Research Centre project, a partnership between La Trobe University, Northern Health, and the Victorian Department of Health.